predictors and outcomes of positive body image in young...
TRANSCRIPT
Predictors and Outcomes of Positive Body Image in Young Women and Adolescent
Girls
Rachel Andrew
B.Psych. (Hons.)
A thesis submitted to Flinders University in partial fulfilment of the requirements for the
degree of Doctor of Philosophy (Clinical Psychology)
School of Psychology
Faculty of Social and Behavioural Sciences
Flinders University
November 2015
i
Table of Contents
Table of Contents ........................................................................................................................ i
Summary .................................................................................................................................. iii
Declaration ................................................................................................................................. v
Acknowledgements ................................................................................................................... vi
CHAPTER 1: General Introduction ........................................................................................... 1
Chapter Overview ...................................................................................................................... 1
Development of the Concept of Positive Body Image............................................................... 1
Research in Adult Women ......................................................................................................... 5
Research in Adolescent Girls ..................................................................................................... 6
Theoretical Models of Positive Body Image ............................................................................. 7
Aims of the Present Thesis ........................................................................................................ 9
Thesis Outline .......................................................................................................................... 10
References ................................................................................................................................ 12
CHAPTER 2: Study 1 - Predictors of Positive Body Image in Women .................................. 18
Abstract .................................................................................................................................... 19
Method ..................................................................................................................................... 25
Results ...................................................................................................................................... 29
Discussion ................................................................................................................................ 34
References ................................................................................................................................ 40
CHAPTER 3: Study 2 – Health Outcomes in Women ............................................................ 49
Abstract .................................................................................................................................... 50
Method ..................................................................................................................................... 55
Results ...................................................................................................................................... 58
Discussion ................................................................................................................................ 62
References ................................................................................................................................ 68
CHAPTER 4: Study 3 – Protection Against the Thin Ideal..................................................... 76
Abstract .................................................................................................................................... 77
Introduction .............................................................................................................................. 78
Method ..................................................................................................................................... 81
Results ...................................................................................................................................... 86
Discussion ................................................................................................................................ 92
References ................................................................................................................................ 98
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CHAPTER 5: Study 4 – Cross-sectional Analysis in Adolescent Girls ................................ 103
Abstract .................................................................................................................................. 104
Methods.................................................................................................................................. 109
Results .................................................................................................................................... 112
Discussion .............................................................................................................................. 116
References .............................................................................................................................. 120
CHAPTER 6: Study 5 – Longitudinal Follow-up of Adolescent Girls ................................. 125
Abstract .................................................................................................................................. 126
Method ................................................................................................................................... 132
Results .................................................................................................................................... 138
Discussion .............................................................................................................................. 147
References .............................................................................................................................. 156
CHAPTER 7: General Discussion ......................................................................................... 164
Chapter Overview .................................................................................................................. 164
Summary of Findings ............................................................................................................. 164
Implications for the Major Aims............................................................................................ 165
Theoretical Implications ........................................................................................................ 168
Practical Implications............................................................................................................. 169
Conclusion ............................................................................................................................. 172
References .............................................................................................................................. 173
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Summary
The body image field has experienced a recent shift in focus to include the
examination of positive, as opposed to negative, aspects of body image. However, as yet little
is known about what predicts positive body image, and what outcomes result from possessing
positive body image. Thus, the first aim of the current thesis was to investigate factors that
might lead to positive body image (operationalised as body appreciation) in young women
and adolescent girls. The second aim was to examine potential beneficial outcomes of
positive body image, especially in the health domain. These aims were addressed in a series
of studies utilising correlational, experimental and longitudinal research designs.
The thesis consists of five papers (three published, one accepted for publication and
one under review). The first two studies addressed potential predictors and health behaviour
outcomes of body appreciation in young women. Study 1 showed that less appearance media
and more non-appearance media consumption and self-compassion predicted lower
engagement in appearance processing, which along with perceived body acceptance by
others, predicted body appreciation. Study 2 showed that body appreciation predicted more
engagement in sun protection and skin screening, and less weight-loss behaviour, over and
above levels of body dissatisfaction.
Study 3 experimentally investigated whether body appreciation could protect against
thin-ideal media induced body dissatisfaction. Results showed that body appreciation was
protective, such that women with low body appreciation experienced an increase in body
dissatisfaction as a result of exposure to thin-ideal images, while those with high body
appreciation did not. This paper also identified and investigated some specific media
protective strategies.
Studies 4 and 5 examined positive body image in adolescent girls. Study 4 confirmed
cross-sectionally a modified acceptance model of intuitive eating. Perceived body acceptance
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by others was negatively related to both self-objectification and appearance comparison, both
of which were negatively associated with body appreciation, which in turn was related to
greater intuitive eating. Study 5 was a longitudinal follow-up, examining predictors and
outcomes of body appreciation over a one-year time period. Findings supported a prospective
modified acceptance model of intuitive eating, with body appreciation shown to be the
strongest predictor of intuitive eating over one year. In addition, greater perceived body
acceptance by others and less dieting was shown to prospectively predict body appreciation,
and body appreciation prospectively predicted increased physical activity participation and
decreased dieting, alcohol and cigarette use one year later.
Overall, the findings of the studies extend knowledge about factors predicting and
stemming from positive body image. Accordingly, the results contribute to the theoretical and
conceptual understanding of positive body image, as well as provide practical implications
for interventions designed to enhance positive body image.
v
Declaration
I certify that this thesis does not incorporate without acknowledgment any material
previously submitted for a degree or diploma in any university; and that to the best of my
knowledge and belief it does not contain any material previously published or written by
another person except where due reference is made in the text.
……………………………………
Rachel Andrew, B. Psych. (Hons.)
vi
Acknowledgements
To my supervisor Marika Tiggemann, I have learnt a great deal from you and I
consider myself very lucky that I was able to complete this research under your guidance.
Thank you for your enthusiasm, your attention to detail, your wisdom and for motivating me
to keep on track even when my mind was on clinical classes and placements. Thank you to
my associate supervisor Levina Clark for all your fantastic input and guidance, I was very
lucky to be your first PhD student. I am also very grateful to Tim Windsor, Paul Williamson
and Gemma Sharp for their statistics advice at various times over the four years.
To my fellow Flinders PhD friends – Ashleigh, Naomi, Sophie, Stacey O, Stacey TA,
Jamie-Lee, Sue, Belinda, Rie and Clare, thank you for all your support, always making my
day more enjoyable and giving me coffee and lunch breaks to look forward to. A special
thank you to Ash for our frequent debriefs and for sharing these four years with me through
both the exciting moments and various struggles to the finish line – we did it!
To my Mum, I would not be where I am today without all your love and support, and
the sacrifices you have made for me. Thank you for always making me feel like anything was
achievable. To Dad and Bernadette, thank you both for the constant encouragement and
always helping me to de-stress with amazing dinners and catch-ups filled with laughter.
To my husband Jason, I am sorry that I cannot list you as a co-author on this thesis
like you wanted, but I hope you know how much I have appreciated your love, friendship and
endless support of me over these last four (and more) years. Thank you for making me smile
and laugh every single day. I am not so sure I could have done this without you, because your
unwavering belief in me kept me going when I thought I was not capable of it.
Finally, thank you to our little girl who was able to hold off on gracing us with her
presence before the submission of this thesis. I cannot wait to meet you!
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CHAPTER 1: General Introduction
Chapter Overview
This general introductory chapter aims to provide a brief background to positive body
image research, with a view to setting the studies of the thesis within their theoretical and
historical context. First, the development of positive body image as a distinct construct is
outlined. Next, the research which had been conducted prior to the commencement of the
current thesis is reviewed. The chapter concludes with the main aims and outline of the
thesis.
Development of the Concept of Positive Body Image
Body image is a complex construct that refers to the multifaceted (e.g., perceptual,
cognitive, affective and behavioural) experience of one’s body, including physical
appearance (Cash & Pruzinsky, 1990). Despite this broad conceptualisation, up until recently,
body image theory and research had been largely pathology based and limited to
investigations of body image dysfunction (Smolak & Cash, 2011). Positive body image was
not previously examined independently, largely because it was conceptualised as existing at
the opposite end of a continuum from negative body image, that is, as equivalent to body
satisfaction (Tylka, 2011). This narrow research focus restricted the understanding of the
multi-dimensional nature of body image and potential benefits of possessing positive body
image. In the last decade, however, there has been a shift to broaden body image research to
include positive and adaptive aspects. This may have been partially initiated by Cash and
Pruzinsky (2002) in the first edition of the book, Body Image: A Handbook of Theory,
Research and Clinical Practice. Here, scholars were challenged to direct research attention to
the development and experience of positive body image. This call has been echoed more
recently by Grogan (2008; 2010) and Smolak and Cash (2011).
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In one of the first attempts to explore how positive body image differed from negative
body image, Williams, Cash and Santos (2004) examined correlates of positive body image.
In their study, women with positive body image, negative body image and normative body
image discontent were identified based on cluster analysis. Results indicated that women with
positive body image exhibited more appearance satisfaction, lower body image distress, and
their body image had a more positive impact on their life than women with negative or
normative body image discontent. Specifically, women with positive body image coped more
adaptively with body image threats and engaged in less appearance fixing and avoidance. The
positive body image group also reported less maladaptive eating behaviour, as well as higher
optimism and self-esteem. This study provided insight into how positive body image was
differentially associated with indicators of well-being, and was therefore separate from low or
normal body dissatisfaction.
Around the same time, Avalos, Tylka and Wood-Barcalow (2005) published a
seminal paper describing the development of a 13-item measure of one major aspect of
positive body image, named body appreciation. This paper outlined how the Body
Appreciation Scale (BAS) was constructed based on previous positive body image theorising
to assess four aspects of body appreciation: a) possessing positive opinions about one’s body;
b) accepting one’s body regardless of perceived flaws and objective weight and shape; c)
showing respect for one’s body by providing attention to bodily needs and engaging in
healthy behaviours; and d) protection of body image through rejection of unrealistic thin-
ideal media images. The scale was psychometrically evaluated and found to be reliable and
valid in samples of college women. Importantly, body appreciation was found to be related to
aspects of psychological well-being (e.g., self-esteem, optimism, proactive coping), above
and beyond levels of negative body image. These findings provided support for the argument
that positive body image (body appreciation) was more complex than low levels of negative
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body image and thus deserved to be examined in its own right. Also indicative of the growing
interest in positive body image, the first edition of Grogan’s (1999) comprehensive text, Body
Image: Understanding Body Dissatisfaction in Men, Women and Children, contained no
chapter on positive body image, but by the second edition in 2008, this construct was viewed
as important enough to warrant a specific chapter on its promotion (Grogan, 2008).
In their recent overview of the foundations and conceptualisation of positive body
image, Tylka and Wood-Barcalow (2015a) identified two additional factors that drove
increasing interest in the area. The first was the establishment of a new journal in 2004, Body
Image: An International Journal of Research, which specifically encouraged submission of
articles examining all (including positive and adaptive) aspects of body image. This gave
researchers interested in studying positive body image reassurance that a journal would be
receptive to their research (Tylka & Wood-Barcalow, 2015a). The second important factor
was the inclusion of a chapter dedicated to positive body image (Tylka, 2011) in the second
edition of Body Image: A Handbook of Science, Practice, and Prevention (Cash & Smolak,
2011), released almost 10 years after the first edition. This chapter was accompanied by an
entry in the Encyclopaedia of Body Image and Human Appearance (Tylka, 2012).
In these latter two publications, Tylka (2011, 2012) described positive body image
and outlined the rationale and evidence supporting its conceptualisation as a distinct
construct. This was in part informed by qualitative research involving interviews with
college-aged women and body image experts (Wood-Barcalow, Tylka, & Augustus-Horvath,
2010), and Swedish adolescent girls and boys (Frisén & Holmqvist, 2010). Some core
features of positive body image identified were having love, respect and acceptance for one’s
body, appreciation for the body’s uniqueness and function, broadly defining beauty,
“filtering” information in a body protective manner, being media literate, having an
awareness of one’s physical needs and treating the body with care (Tylka, 2011, 2012).
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Relationships between positive body image and environmental factors were also proposed to
be reciprocal and bi-directional in nature. Tylka (2011, pp. 62-63) concluded by posing seven
specific research questions in need of answer:
1. Whether qualitative studies would find similar characteristics associated with
positive body image in men, different age groups and cultures.
2. Whether age, culture and other individual factors might influence expression of
positive body image.
3. What makes “filtering” protective, and how does the transition from negative to
positive body image occur.
4. What the strongest predictors and outcomes of positive body image are, utilising
longitudinal studies.
5. Whether positive body image relates to detection of disease and physical self-care.
6. How positive body image might be fostered in overweight people who face weight
discrimination.
7. Whether positive body image can prevent binge eating and eating in the absence of
hunger.
These questions played a central role in the formulation of the aims and objectivities
of the current thesis, and accordingly, several aspects of these questions were addressed. The
questions were addressed by examining cross-sectional and longitudinal predictors and
outcomes of positive body image (research question 4), exploring physical care and screening
for disease as potential outcomes (question 5), testing whether positive body image is
predictive of an adaptive style of eating (question 7), examining media-specific processing
strategies potentially related to “filtering” (question 3), and expanding the examination of
positive body image to adolescent girls (question 2).
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Research in Adult Women
The publication of the BAS (Avalos et al., 2005) was the impetus for the expansion of
research involving positive body image, as it provided researchers with a psychometrically
sound tool with which to operationalise this aspect of body image. Since then, a number of
correlational studies with adult female samples have reported significant associations
between body appreciation and a range of positive psychological characteristics. These
include greater self-compassion (Wasylkiw, MacKinnon, & MacLellan, 2012), self-esteem
(Swami, Stieger, Haubner, & Voracek, 2008), and optimism (Dalley & Vidal, 2013), and less
attachment anxiety and avoidance, maladaptive perfectionism and depression (Iannantuono &
Tylka, 2012). Body appreciation has also been shown to relate to greater perceived general
unconditional acceptance (Augustus-Horvath & Tylka, 2011; Oh, Wiseman, Hendrickson,
Phillips, & Hayden, 2012), perceived social support (Augustus-Horvath & Tylka, 2011), and
perceived body acceptance by others (Augustus-Horvath & Tylka, 2011; Avalos & Tylka,
2006; Oh et al., 2012).
More general aspects of personality have also been investigated in relation to body
appreciation in women. Body appreciation has been found to be positively associated with
extraversion, conscientiousness (Swami, Hadji-Michael, & Furnham, 2008), and trait
emotional intelligence (Swami, Begum, & Petrides, 2010), and negatively associated with
neuroticism (Swami, Hadji-Michael, et al., 2008).
Finally, associations between body appreciation and aspects of negative body image
have been examined. Studies have reported inverse relationships between body appreciation
and thin-ideal and athletic-ideal internalisation (Swami, 2009; Swami et al., 2010; Swami et
al., 2012). Negative associations between body appreciation and body dissatisfaction, drive
for thinness, social physique anxiety, body image avoidance, body checking (Swami et al.,
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2012), and self-objectification (Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh
et al., 2012) have also been demonstrated.
Although one proposed feature of positive body image and body appreciation is
engagement in behaviours that benefit physical health (Avalos et al., 2005; Tylka, 2011,
2012), no health behaviours outside of intuitive eating had previously been examined.
Intuitive eating refers to an adaptive style of eating that occurs in response to internal cues
(Tribole & Resch, 1995; Tylka, 2006) and has been found to be positively associated with
body appreciation in women (Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh
et al., 2012). One study also demonstrated a positive association between body appreciation
and women’s sexual functioning (Satinsky, Reece, Dennis, Sanders, & Bardzell, 2012).
Research in Adolescent Girls
Compared with adult women, considerably less research has examined the
presentation of positive body image in adolescent girls. This is perhaps surprising given that
adolescence is a period associated with substantial physical, cognitive and social change
(Eccles, 1999), and in which there is a strong focus on appearance and weight control (Paxton
et al., 1991). In particular, adolescent girls experience dramatic physical changes in body
composition and shape, including increased fat deposits on areas such as the hips (Wertheim
& Paxton, 2011). These changes move girls further away from society’s narrowly defined
view of beauty, i.e., the thin ideal (Calogero & Thompson, 2010), an appearance standard
repeatedly communicated through various forms of media that girls consume (Levine &
Chapman, 2011).
Two previous qualitative studies sought to explore positive body image in Swedish
adolescent girls and boys. These studies found that adolescents with positive body image
placed less emphasis on negative appearance comments (Frisén & Holmqvist, 2010), and
were aware and critical of the media’s unrealistic appearance ideals (Holmqvist & Frisén,
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2012). The small amount of quantitative research that had examined body appreciation in
adolescents before the current research commenced showed that in Spanish girls, body
appreciation positively correlated with self-esteem and adaptive coping, and negatively
related to disordered eating symptomatology (Lobera & Ríos, 2011; Lobera, Ríos, Fernández,
& Casals Elsa Sánchez, 2011). These studies provided some initial insights, but further
research examining the expression and trajectory of positive body image in adolescent girls
was necessary.
Theoretical Models of Positive Body Image
After establishing empirical correlates of positive body image, the next step was to
develop theoretical models. Thus far there have been three models involving positive body
image that have been proposed. The first, the acceptance model of intuitive eating (Avalos &
Tylka, 2006), proposes that perception of unconditional acceptance when growing up predicts
greater perceived body acceptance by others, which in turn leads to greater emphasis on body
function (i.e., lower self-objectification) and body appreciation. Body appreciation then
directly predicts intuitive eating. This model has been confirmed in samples of undergraduate
women (Avalos & Tylka, 2006), female college athletes (Oh et al., 2012), and young, early-
adult and middle-aged women (Augustus-Horvath & Tylka, 2011). The confirmation of this
model in several samples indicates that enhancing body appreciation may be one way to
foster an adaptive and intuitive eating style in women.
Iannantuono and Tylka (2012) sought to test a specific empirical model of positive
body image in college women. They postulated that certain interpersonal and intrapersonal
factors would predict body appreciation, which in turn would influence depressive symptoms
and intuitive eating. The findings indicated that less maladaptive perfectionism, eating-related
caregiver messages and adult attachment anxiety were associated with greater body
appreciation, which in turn was related to greater intuitive eating. Although body appreciation
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was negatively correlated with depressive symptomatology, body appreciation did not
contribute unique variance to depression after accounting for attachment anxiety and
perfectionism.
Menzel and Levine (2011) put forth a model focusing on the ways in which positive
body image might develop. Using competitive athletics as an example, engagement in
embodying activities (i.e., activities that involve a mind-body connection) was proposed to
influence positive body image, both directly and indirectly via decreased self-objectification.
This model was recently supported in a sample of adult women who participated in one
example of an embodying activity, namely, belly dance (Tiggemann, Coutts, & Clark, 2014).
In this study, belly dance participants reported higher levels of body appreciation compared
to non-belly dancers, a difference that was mediated by reduced self-objectification
(Tiggemann et al., 2014).
The studies in the present thesis are situated at this point in time in relation to the
progression of positive body image research. The three outlined models were useful in
pinpointing potential predictors of positive body image, in particular, perceptions of body
acceptance from other people, engagement in embodying activities and psychological
variables. Intuitive eating was also identified as a potential outcome. Despite this, the range
of potential predictors and outcomes that had been tested was still very limited. In particular,
no health outcomes outside of intuitive eating had been examined. Likewise, minimal
research had investigated the presentation of positive body image in groups other than young
adult women. Thus, the research within the present thesis attempted to expand upon potential
predictors and outcomes of positive body image, and to extend this examination to adolescent
girls.
Subsequent to the completion of the studies presented in the thesis, the journal Body
Image published a special issue in 2015 which focused on positive body image. This issue
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highlighted the growing interest in positive and adaptive aspects of body image. Included
were reviews of the foundation and conceptualisation of positive body image (Tylka &
Wood-Barcalow, 2015a), the presentation of positive body image in special populations
(Tiggemann, 2015), the potential utility of enhancing positive body image in the prevention
of disordered eating (Piran, 2015) and treatment of disordered eating (Cook-Cottone, 2015),
and future research directions (Halliwell, 2015).
In addition, the special issue presented the revision of the BAS, the Body
Appreciation Scale-2 (BAS-2, Tylka & Wood-Barcalow, 2015b). The BAS-2 contains 10
items and measures positive body image more generally, including assessing body love and
acceptance, broad definitions of beauty and the influence of inner positivity on outward
behaviour (Tylka & Wood-Barcalow, 2015b). The authors also provided further evidence for
the conceptualisation of positive body image as a distinct construct. Specifically, body
appreciation (measured by the BAS-2) was found to account for unique variance in women’s
self-esteem, proactive coping, intuitive eating and disordered eating symptomatology, beyond
levels of body dissatisfaction (Tylka & Wood-Barcalow, 2015b).
Aims of the Present Thesis
Despite the steady growth of positive body image research at the outset of the current
thesis, literature was still in its infancy. Only a small number of potential predictors of
positive body image had been identified. In addition, no research had examined positive
health outcomes outside of intuitive eating. Finally, no quantitative studies had investigated
the presentation of body appreciation in English-speaking adolescent girls.
The current thesis had two main aims. The first was to investigate predictors of
positive body image in adult women and adolescent girls. This aim was addressed by
examining both psychological variables and everyday activities as potential predictors of
body appreciation in young women (Study 1) and in girls (Study 5). The second aim was to
10
examine whether possessing positive body image was beneficial for women and girls’ well-
being. Here, potential health outcomes, in terms of positive behaviours (e.g., using sun
protection) and avoidance of harmful behaviours (e.g., cigarette smoking) were examined in
both young women (Study 2) and adolescent girls (Study 4 and Study 5). Another potential
outcome of positive body image, namely protection against media-induced body
dissatisfaction, was investigated in young women (Study 3). Study 5 addressed the two aims
with a prospective study of adolescent girls over a one-year time period. The use of a
longitudinal design also allowed relationships to be tested for directionality (including bi-
directionality).
Thesis Outline
The remainder of the thesis consists of six further chapters, reporting on five
empirical studies. In each of the studies, positive body image was operationalised as body
appreciation, as measured by the BAS (Avalos et al., 2005). The first three studies were
conducted with young adult women. Chapter 2 presents the results of Study 1 which
examined a range of potential predictors (everyday activities and psychological variables) of
positive body image, as well as potential mechanisms. Chapter 3 presents the results of Study
2 which investigated health outcomes of positive body image (e.g., sun protection) in a sub-
sample of young women from Study 1. Chapter 4 presents Study 3 which experimentally
examined whether possessing positive body image protects against body dissatisfaction
resulting from acute exposure to thin-ideal advertisements, undertaken with a smaller subset
of women from Study 1.
Chapters 5 and 6 outline the results of a study involving a moderately large sample of
adolescent girls. Chapter 5 contains a cross-sectional analysis of the acceptance model of
intuitive eating (Avalos & Tylka, 2006), referred to as Study 4. Chapter 6 presents the
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longitudinal follow-up, referred to as Study 5, examining predictors and outcomes of positive
body image over a one-year time period.
Finally, Chapter 7 presents an integrated discussion of findings from the studies
within the thesis, including their significance and contribution to the current literature. Both
theoretical and practical implications are drawn.
All chapters have been formatted as manuscripts for publication. Three have been
published (Chapters 3, 4 and 5), one has been accepted for publication (Chapter 6), and one is
currently under review (Chapter 2). Each paper has been written in accord with individual
journal requirements and so formatting may vary slightly. In addition, because the
background information is largely similar for each study, there is some repetition in the
Introduction and Discussion sections of the presented studies.
12
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18
CHAPTER 2: Study 1 - Predictors of Positive Body Image in Women
Predictors of Positive Body Image in Young Adult Women
Rachel Andrew, Marika Tiggemann, and Levina Clark
School of Psychology, Flinders University, South Australia
Corresponding author: Rachel Andrew, School of Psychology, Flinders University, GPO
Box 2100, Adelaide 5001, South Australia, Australia. Email:
Statement of co-authorship:
All authors were involved in the formulation of the study concept and design. Rachel Andrew
collected the data, completed the data analysis and the initial draft of the manuscript. Marika
Tiggemann and Levina Clark edited multiple revisions of the manuscript.
This manuscript is currently under review.
19
Abstract
This study aimed to examine a range of predictors of positive body image in young adult
women. Participants were 266 women who completed an online questionnaire measuring
body appreciation, sports and hobby participation, media consumption, perceived body
acceptance, self-compassion and autonomy. Potential mechanisms in predicting body
appreciation assessed were self-objectification, social appearance comparison and thin-ideal
internalisation. Results indicated that greater perceived body acceptance and self-compassion,
and lower appearance media consumption, self-objectification, social comparison and thin-
ideal internalisation were related to greater body appreciation. An integrated structural model
showed that appearance media (negatively) and non-appearance media and self-compassion
(positively) were associated with lower self-objectification, social comparison and thin-ideal
internalisation, which in turn were related to greater body appreciation. Additionally,
perceived body acceptance shared a direct relationship with body appreciation. The results
contribute to an understanding of the potential ways in which positive body image might
develop, thereby highlighting intervention targets for fostering positive body image in
women.
Key words: positive body image, body appreciation, predictors, structural equation
modelling, young women
20
Body image is widely accepted to be a complex and multi-faceted construct
(Pruzinsky & Cash, 2002). Increasingly, research is reflecting this understanding with a shift
from a sole focus on the negative aspects of body image to a broader investigation of other
facets, including positive body image (Tylka, 2011). Generally, positive body image can be
defined as holding love, confidence, respect, appreciation and acceptance of one’s physical
appearance and abilities (Wood-Barcalow, Tylka, & Augustus-Horvath, 2010). Positive body
image has been investigated thematically in qualitative studies (e.g., Bailey, Gammage, van
Ingen, & Ditor, 2015; Frisén & Holmqvist, 2010; Holmqvist & Frisén, 2012; McHugh,
Coppola, & Sabiston, 2014; Wood-Barcalow et al., 2010), but is now most often
operationalised as body appreciation using the Body Appreciation Scale (BAS, Avalos,
Tylka, & Wood-Barcalow, 2005; BAS-2, Tylka & Wood-Barcalow, 2015). The BAS
measures positive opinions and acceptance of one’s body, provision of attention to bodily
needs and engagement in a style of cognitive processing that protects against potentially
harmful body-image related messages (Avalos et al., 2005).
There is now considerable evidence linking body appreciation to a wide range of
positive psychological constructs and indicators of good health. In women, body appreciation
has been shown to be associated with factors related to well-being such as self-esteem,
adaptive coping, life satisfaction, positive affect and optimism (Avalos et al., 2005; Dalley &
Vidal, 2013; Swami, Stieger, Haubner, & Voracek, 2008; Tylka & Kroon Van Diest, 2013).
Body appreciation is also related to positive health outcomes including intuitive eating
(Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh, Wiseman, Hendrickson,
Phillips, & Hayden, 2012), sexual functioning (Satinsky, Reece, Dennis, Sanders, & Bardzell,
2012), and sun protection and cancer screening behaviours (Andrew, Tiggemann, & Clark,
2014; Gillen, 2015). In addition, experimental studies have demonstrated evidence of a
21
protective effect of body appreciation against media-induced body image dissatisfaction in
young women (Andrew, Tiggemann, & Clark, 2015a; Halliwell, 2013).
Despite the increasing interest in positive body image, to date, only a handful of
studies have examined predictors of positive body image. Yet the identification of predictors
is important for both the theoretical conceptualisation of positive body image, as well as for
locating potential points for intervention. Thus, the present study sought to examine a range
of potential predictors, covering both everyday activities as well as several psychological
variables. Some of the examined predictors were derived from existing models in the
literature.
Menzel and Levine’s (2011) embodiment model of positive body image contends that
a key predictor is engaging in embodying activities (those that involve mind-body
integration). Embodying activities are proposed to have both a direct effect on positive body
image, as well as an indirect effect via reduced self-objectification (i.e., the adoption of an
observer's perspective, Fredrickson & Roberts, 1997). Thus far, this model has been tested in
women who participate in belly dance (one example of an embodying activity), who were
shown to have higher body appreciation than non-belly dancers, mediated by reduced self-
objectification (Tiggemann, Coutts, & Clark, 2014). Women who exercise for functional,
health and enjoyment reasons (over appearance-based motivations) have also been shown to
report greater body appreciation (Homan & Tylka, 2014; Tylka & Homan, 2015).
Accordingly, the first predictor tested in the current study was participation in sports and
physical activities. In addition, Halliwell (2015) has proposed that participation in other
activities that emphasise the mind-body connection and capabilities (e.g., playing a musical
instrument) may also be related to positive body image. Thus, we also examined a range of
engaging hobbies that allow individuals to be ‘in’ the body (Piran, 2002).
22
In addition to physical activities and hobbies, we wished to examine another type of
everyday factor that might influence positive body image, namely media consumption. The
mass media, including television, magazines and the internet, are a major source of messages
regarding appearance standards and unhealthy beauty ideals, in particular the thin ideal
(Levine & Chapman, 2011). Correlational and experimental research has shown that
exposure to thin-ideal media images is linked to body image disturbance and endorsement of
disordered eating (Grabe, Ward, & Hyde, 2008; Groesz, Levine, & Murnen, 2002). Therefore
women who consume more media containing appearance messages (e.g., fashion magazines)
would be expected to be more critical and less accepting of their own appearance and body.
To date, greater exposure to Western media has been shown to be associated with lower body
appreciation in British (Swami, Hadji-Michael, & Furnham, 2008), Malaysian (Swami,
Kannan, & Furnham, 2012) and Zimbabwean women (Swami, Mada, & Tovée, 2012). On
the other hand, consumption of media that are not focused on appearance (e.g., the news)
might be protective of positive body image.
A range of psychological predictors were also investigated. The first, perceived body
acceptance by others, has previously been investigated as part of the acceptance model of
intuitive eating (Avalos & Tylka, 2006). In this model, perceived body acceptance by others
is conceptualised as leading to increased body appreciation, and in turn, greater intuitive
eating. Of particular relevance here, individuals who perceive that others accept their body as
it is, despite any perceived flaws, are more likely to be accepting and appreciative of their
own body (Avalos & Tylka, 2006). Cross-sectional examinations of the acceptance model of
intuitive eating have shown that perceived acceptance of one’s body by others predicts higher
body appreciation, both directly and indirectly via reduced self-objectification and social
comparison (Andrew, Tiggemann, & Clark, 2015b; Augustus-Horvath & Tylka, 2011;
23
Avalos & Tylka, 2006; Oh et al., 2012). Thus we included perceived body acceptance by
others as a potential psychological predictor.
Two other psychological variables were also examined as potential predictors,
namely, self-compassion and autonomy. Previous research has demonstrated a positive
association between self-compassion and body appreciation in women (Albertson, Neff, &
Dill-Shackleford, 2014; Wasylkiw, MacKinnon, & MacLellan, 2012). Individuals with self-
compassion treat themselves with non-judgemental kindness when personal inadequacies are
brought to attention (Neff, 2003a). In relation to appearance, self-compassionate women who
become aware of appearance-based short comings should respond with non-judgement and
acceptance (Wasylkiw et al., 2012). Thus, we should expect self-compassion to be predictive
of greater body appreciation.
Autonomy was the final psychological variable to be examined as a predictor of
positive body image. Autonomy has not previously been investigated in relation to body
appreciation or to body image more generally. However, those who are self-determined and
autonomous act on the basis of personal choice and not the influence of others (Deci & Ryan,
1985). Such individuals may be less receptive to outside negative appearance messages that
emphasise beauty standards. In qualitative studies, adolescent girls and boys with positive
body image report not placing importance on negative appearance comments (Frisén &
Holmqvist, 2010) or societal appearance ideals (Holmqvist & Frisén, 2012). These qualitative
findings may be indicative of a greater level of autonomy allowing independent evaluation of
appearance messages, which may contribute to greater appreciation of one’s body.
In order to better understand how different factors may lead to enhanced positive body
image, the current study also sought to examine potential mechanisms involved in
relationships between predictors and body appreciation. The three potential mechanisms
tested were self-objectification, social appearance comparison and thin-ideal internalisation.
24
These three variables have been shown to be inter-correlated (e.g., Fitzsimmons-Craft et al.,
2012), and all relate essentially to the importance placed on appearance or the way
appearance is processed. Self-objectification refers to the surveillance and self-monitoring of
one’s own appearance from an outsider’s perspective (Fredrickson & Roberts, 1997). Social
appearance comparison involves gathering information for self-evaluation (Festinger, 1954)
by assessing one’s appearance against other people’s appearance. Finally, thin-ideal
internalisation refers to the adoption and incorporation of a thin-ideal appearance as a
personal value system (Thompson & Stice, 2001). Importantly, body appreciation has
previously been shown to be negatively associated with all the proposed mechanisms of self-
objectification (e.g., Avalos & Tylka, 2006), social comparison (Andrew et al., 2015b;
Homan & Tylka, 2015) and thin-ideal internalisation (Swami, 2009; Swami, Begum, &
Petrides, 2010; Swami & Tovée, 2009).
Previous studies have also demonstrated significant relationships between the
postulated predictors tested here and the three proposed mediating appearance processing
mechanisms. Higher self-objectification has been shown to be associated with lower
participation in sports in adolescent girls (Slater & Tiggemann, 2012), more appearance-
based media consumption (e.g., Harper & Tiggemann, 2008), and also with lower perceived
body acceptance by others (e.g., Augustus-Horvath & Tylka, 2011), self-compassion (Daye,
Webb, & Jafari, 2014; Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011) and
autonomy (McKinley, 1999). Social comparison has been shown to be positively related to
thin-ideal media exposure (Tiggemann & McGill, 2004), and negatively related to perceived
body acceptance by others in adolescent girls (Andrew et al., 2015b), and self-compassion in
adult women (Neff & Vonk, 2009). Finally, thin-ideal internalisation has been found to be
positively associated with mass media consumption (see, Grabe et al., 2008; Levine &
Murnen, 2009) and thinness pressure from family, friends, partners and the media (Tylka,
25
Russell, & Neal, 2015), and negatively associated with self-compassion (Tylka et al., 2015)
and autonomy (Pelletier, Dion, & Lévesque, 2004).
In sum, the current study aimed to broaden the understanding of the ways in which
positive body image might develop in young women by examining a range of predictors.
Specific predictors examined were participation in sports and physical activities, engagement
in hobbies, consumption of appearance and non-appearance media, and the psychological
variables of perceived body acceptance by others, self-compassion and autonomy. In
addition, we examined three other predictors conceptualised as potential mechanisms of
influence in these relationships, namely, self-objectification, social comparison and
internalisation of the thin ideal.
Method
Participants
Participants were 266 women aged 18 to 30 years (M = 20.04, SD = 3.07) who were
undergraduate students at an urban university in South Australia. The majority of participants
identified as Caucasian or White (88.8%), with 8.9% Asian, 0.4% Aboriginal or Torres Strait
Islander, 0.4% African, and 1.5% identifying as an ‘other’ ethnicity.
Measures and Materials
Background information. Participants were asked to provide their age, height,
weight, and ethnicity. Body mass index (BMI) was then calculated as weight [kg] / height2
[m2].
Body appreciation. Body appreciation was measured with the Body Appreciation
Scale (BAS) of Avalos et al. (2005). The BAS assesses the acceptance, respect, and attention
given to one’s bodily needs, and favourable opinions held for one’s body. Participants rate 13
items on a 5-point scale (1 = never, to 5 = always). Items include “My self-worth is
independent of my body shape or weight”, and “I engage in healthy behaviours to take care
26
of my body”. Scores are averaged, ranging from 1 to 5 such that higher scores are indicative
of greater body appreciation. The BAS has been found to conform to a unidimensional factor
structure and has established good internal reliability (α = .91-.94), three week test-retest
reliability (r = .90), and convergent validity among U.S. college women (Avalos et al., 2005).
A previous study with a sample of Australian women (Tiggemann & McCourt, 2013) found
the BAS to have high internal reliability (α = .90). The scale also had high internal reliability
in the present sample (α = .93).
Activities. Physical and other types of activities that women might engage in were
assessed with a measure constructed for the study. Ten items addressed sports and physical
activities (e.g., organised sports, running, hiking), and 10 items addressed hobbies or other
engaging activities (e.g., playing a musical instrument, arts and crafts, volunteering).
Participants indicated whether or not they engaged in each listed activity, and if so, how
many sessions per week they engaged in that activity (frequency), and for how many minutes
per session (duration). Time spent on each activity per week was calculated by multiplying
each activity’s frequency by its duration. Time spent engaged in physical activities was
calculated by totalling minutes spent on the 10 sporting and physical activities. Time spent on
hobbies was calculated by totalling minutes spent on the 10 hobbies listed.
Media consumption. A set of eight items constructed for this study assessed media
consumption. The first three questions examined magazine consumption. Participants were
asked to rate how often they read “Fashion magazines (e.g., Grazia, Vogue)”, “Women’s
magazines (e.g., Woman’s Day, Cleo)” and “Magazines that are not women’s magazines
(e.g., House and Garden)”, on a 4-point scale (1 = never, 4 = every time an issue comes out).
The remaining five items were rated on a 5-point scale (1 = never, 5 = all the time). The first
two questions asked participants how often they view “Fashion websites/blogs/online
material”, and how often they use “Social media (e.g., Facebook, Twitter, Youtube)”. Finally,
27
television viewing was assessed with three items asking participants to rate how often they
watch “Soapies or dramas”, “Music television shows”, and “Information based shows (e.g.,
documentaries or the news)”. From these items, measures of total appearance and non-
appearance media consumption were created. The measure of total appearance media
summed the six items assessing consumption of fashion magazines, women’s magazines,
fashion websites, social media, and watching soapies and music television. The two items
measuring non-appearance media (reading magazines that are not women’s magazines and
watching information based shows) were summed to create a measure of total non-
appearance media consumption.
Body acceptance by others. Perceived body acceptance by others was measured
using the Body Acceptance by Others Scale (BAOS, Avalos & Tylka, 2006). This scale
assesses weight and shape acceptance from different sources (i.e., friends, family, dating
partners, society and the media). We used six items to measure perceived acceptance of shape
and weight from three sources: family, friends and people who they have dated. An example
item is: “I’ve felt acceptance from my friends regarding my body shape and/or weight”. The
six items were rated on a 5-point scale (1= never, 5 = always), and were averaged with higher
scores reflecting greater perceived acceptance of body weight and shape by others. In a
sample of U.S. college women (Avalos & Tylka, 2006), the original scale was shown to have
acceptable internal reliability (α = .90). This was also the case in the current sample (α = .86).
Self-compassion. Self-compassion was assessed by the Self-Compassion Scale-Short
Form (SCS-SF, Raes, Pommier, Neff, & Van Gucht, 2011). Participants rate 12 items on a 5-
point scale (1 = almost never, 5 = almost always), with higher scores representing greater
self-compassion. An example item is: “I try to be understanding and patient towards those
aspects of my personality I don’t like”. The SCS-SF total score has been shown to have good
internal consistency (α = .86) and near perfect correlation (r = .98) with the long version of
28
the Self-Compassion Scale (SCS, Raes et al., 2011). The SCS has been shown to have
acceptable construct validity, and to not significantly correlate with a measure of social
desirability (Neff, 2003b). Internal reliability in the current sample was acceptable (α = .85).
Autonomy. Autonomy was measured with a 5-item measure of emotional autonomy
(Noom, Dekovic, & Meeus, 2001). The scale measures degree of perceived independence,
self-confidence and individuality. Participants rated the five items (e.g., “When I disagree
with others, I tell them”) on a 5-point scale (1 = this is a very bad description of me, 5 = this
is a very good description of me). Convergent and divergent validity have been demonstrated
for this scale, with a stronger significant positive correlation with internal locus of control
compared to significant correlations with perceptions of institutional goals and active coping
(Noom et al., 2001). Although Noom et al. (2001) reported a low Cronbach’s alpha (α = .60)
with adolescents, a higher (and acceptable) internal reliability was found in the current study
(α = .77).
Self-objectification. Self-objectification was assessed with the Body Surveillance
Subscale of the Objectified Body Consciousness Scale (OBCS, McKinley & Hyde, 1996).
The subscale measures the extent of monitoring one’s body and thinking of it in terms of
appearance as opposed to how it feels (McKinley & Hyde, 1996). Eight items (e.g., “I think
more about how my body feels than how my body looks”) are rated on a 7-point scale (1 =
strongly agree, 7 = strongly disagree), with a ‘NA’ (not applicable) option available. Scores
range from 8 to 56, with higher scores indicative of higher self-surveillance. The scale has
been shown to have good construct, convergent and discriminant validity, and good internal
consistency (α = .89) with undergraduate women (McKinley & Hyde, 1996). Internal
reliability was similar in the current sample (α = .82).
Social appearance comparison. Social appearance comparison was assessed with the
Physical Appearance Comparison Scale (PACS, Thompson, Heinberg, & Tantleff-Dunn,
29
1991). Participants rate five items measuring tendency to compare overall appearance with
other people’s appearance on a 5-point scale (1 = never, 5 = always). An exemplar item is:
“In social situations, I sometimes compare my figure to the figures of other people”. Internal
consistency has been shown to be acceptable (α = .78) in a female university sample
(O’Brien, Hunter, Halberstadt, & Anderson, 2007), as was the case in the current sample (α =
.74).
Thin-ideal internalisation. Endorsement and acceptance of media messages
regarding unrealistic beauty ideals was assessed by the Internalization Scale of the
Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ, Heinberg, Thompson,
& Stormer, 1995). Participants rate eight items on a 5-point scale (1 = completely disagree, 5
= completely agree). An exemplar item is: “I wished I looked like a swimsuit model”. The
subscale has demonstrated good convergent validity and internal consistency (α = .88,
Heinberg et al., 1995). For the present sample, internal reliability was high (α = .90).
Procedure
The present study was approved by the relevant institutional ethics committee. After
reading an information sheet, participants completed an online questionnaire hosted on a
secure website which contained the measures listed above. Participant consent was indicated
by completion of the questionnaire. Participants were awarded course credit for their
participation, and were provided with a debriefing letter after data collection was complete.
Results
Characteristics of the Sample
Participants were women aged between 18 to 30 years, with a mean age of 20.04
years (SD = 3.07). Participants’ mean self-reported body mass index (BMI) was 23.22 (SD =
4.65), which falls within the ‘normal range’ for adult women (World Health Organization,
2015).
30
The Relationship between Proposed Predictors, Mediators, and Body Appreciation
Table 1 presents the correlations between proposed predictors and mediators, with
body appreciation. As can be seen in the first column, appearance media (negatively), and
perceived body acceptance by others and self-compassion (both positively) were significantly
correlated with body appreciation. Participation in sports and hobbies, non-appearance media
and autonomy were not significantly related to body appreciation. In addition, all three
proposed mediators were inter-correlated and were individually negatively correlated with
body appreciation.
Table 1
Correlations between proposed predictors, mechanisms, and body appreciation
*p < .05. **p < .001.
Body
appreciation
Mediators
Self-
objectification
Social
comparison
Thin-ideal
internalisation
Everyday predictors
Sports and physical
activities
.06 -.16* -.08 -.03
Hobbies and other activities .02 -.03 -.04 -.09
Appearance media -.16* .37** .25** .35**
Non-appearance media .10 -.15* -.15* -.14*
Psychological predictors
Perceived body acceptance .39** -.10 -.14* -.13*
Self-compassion .53** -.38** -.37** -.33**
Autonomy .05 -.13* -.23** -.18*
Mediators
Self-objectification -.47** - .60** .56**
Social comparison -.39** - .60**
Thin–ideal internalisation -.51** -
31
The table also shows relationships between predictors and the proposed mediators. As
can be seen, participation in sports was negatively correlated with self-objectification, but no
other proposed mediating variable, and engagement in hobbies was not significantly related
to any proposed mediating variable. On the other hand, appearance media was correlated
positively, while non-appearance media was correlated negatively, with all three proposed
mediators. Perceived body acceptance by others was negatively related to social comparison
and thin-ideal internalisation, but was not significantly related to self-objectification. Finally,
both self-compassion and autonomy were negatively correlated with all three mediator
variables.
Tests of Indirect Effects of Predictors on Body Appreciation via Proposed Mechanisms
Bootstrapping of 5000 samples using PROCESS macros (Hayes, 2013) was used to
examine indirect (mediating) effects of proposed predictor variables on body appreciation via
self-objectification, social comparison and thin-ideal internalisation. In this approach
mediation is deemed significant if the 95% bias-corrected confidence interval (CI) of the
indirect path does not contain zero. Individual tests of mediation were performed for each
predictor variable on body appreciation, separately for each of the three proposed mediators.
For sports, results showed that there was a significant indirect effect on body
appreciation via self-objectification, b = .003, CI [.001, .006], but not via social comparison,
b = .001, CI [-.001, .003] or thin-ideal internalisation, b = .000, CI [-.002, .003]. For hobbies,
there were no significant indirect effects on body appreciation (self-objectification, b = .000,
CI [-.000, .001]; social comparison, b = .000, CI [-.000, .001]; thin-ideal internalisation b =
.001, CI [-.000, .001]). For appearance media, significant indirect effects on body
appreciation were found via self-objectification, b = -.034, CI [-.050, -.021], social
comparison, b = -.018, CI [-.030, -.009] and thin-ideal internalisation, b = -.037, CI [-.053, -
.023]. The same pattern (but in the opposite direction) was found for indirect effects of non-
32
appearance media on body appreciation (self-objectification, b = .036, CI [.007, .071]; social
comparison, b = .030, CI [.006, .065]; thin-ideal internalisation, b = .040, CI [.004, .082]).
For the psychological variables, significant indirect effects of perceived body
acceptance by others on body appreciation were found through social comparison, b = .043,
CI [.007, .090], and thin-ideal internalisation, b = .057, CI [.001, .117], but not self-
objectification, b = .043, CI [-.006, .101]. There were significant indirect effects of self-
compassion on body appreciation via all of self-objectification, b = .126, CI [.070, .197],
social comparison, b = .086, CI [.039, .151] and thin-ideal internalisation, b = .138, CI [.083,
.207]. Autonomy also indirectly influenced body appreciation via social comparison, b =
.084, CI [.037, .153] and thin-ideal internalisation, b = .088, CI [.023, .167], but not self-
objectification, b = .057, CI [-.001, .120].
Test of an Integrated Model Predicting Body Appreciation
In order to integrate the findings, an overall structural model predicting body
appreciation was constructed (See Figure 1). Participation in hobbies was not included
because of the lack of significant correlations with any other variable. Because the three
proposed mediating variables were highly inter-correlated (Table 1), they were taken as
indicators of one latent variable, here called appearance processing. All other variables were
measured variables. The model was examined using the maximum likelihood method of
structural equation modelling (AMOS v.22). Mean substitution was used to replace the small
amount of missing data. As recommended by Hu and Bentler (1999), the comparative fit
index (CFI), the Tucker-Lewis index (TLI), the standardised root-mean square residual
(SRMR), and the root-mean square error of approximation (RMSEA) were used to evaluate
adequacy of model fit to the data. Values of .95 or higher for CFI and TLI, and .08 and .06 or
lower for SRMR and RMSEA respectively, are indicative of a good fit (Hu & Bentler, 1999).
33
Values of .90-.94 for CFI and TLI, .09-.10 for SRMR and .07-.10 for RMSEA indicate
acceptable model fit.
The fit indices for the initially tested model suggested a less than acceptable fit to the
data: χ² = 103.57, df = 32, p = < .001, CFI = .87, TLI = .82, SRMR = .06, RMSEA = .09.
Modification indices indicated a direct path from perceived body acceptance to body
appreciation. This same direct pathway has been included in previous studies (Augustus-
Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh et al., 2012). With the addition of this
direct path, the fit indices moved to an overall acceptable fit: χ² = 69.49, df = 31, p = < .001,
CFI = .93 (acceptable), TLI = .90 (acceptable), SRMR = .05 (good), RMSEA = .07
(acceptable). The structural coefficients for the model are presented in Figure 1. As can be
seen, consumption of appearance media (positively), non-appearance media (negatively) and
self-compassion (negatively) predicted appearance processing. Engagement in appearance
processing in turn negatively predicted body appreciation. Perceived body acceptance by
others did not have an indirect effect through appearance processing, but did directly predict
body appreciation. In the integrated model, participation in sports and autonomy were not
predictive of appearance processing or body appreciation.
34
Figure 1. Factor loadings and path coefficients for the final structural model. Self-ob = Self-
objectification; SocComp = Social comparison; Intern = Thin-ideal internalisation.
*p < .05. **p < .001.
Discussion
The present study sought to expand upon the current understanding of factors that
predict positive body image in young women. Specifically, the study examined participation
in sports and hobbies, media consumption and psychological variables as predictors of body
appreciation, as well as potential mechanisms involved in these relationships. Our first
finding was that body appreciation was significantly related to a range of potential predictors,
specifically greater perceived body acceptance by others and self-compassion, and lower
Sports and physical
activities
Appearance media
Non-appearance
media
Perceived body
acceptance
Self-compassion
Autonomy
Self-ob
SocComp
Intern
Body appreciation
Body appreciation Body appreciation
Body appreciation
Appearance
processing Body
appreciation
.30**
-.45**
-.07
-.06
-.13*
*
.21***
.36 **
-.06
.76** .73** .76**
-.56**
-.56**
-.56**
35
appearance media consumption, self-objectification, social comparison and thin-ideal
internalisation. The integrated model indicated that lower appearance media and greater non-
appearance media consumption and self-compassion predicted lower appearance processing
(consisting collectively of self-objectification, social comparison and thin-ideal
internalisation), which in turn predicted higher body appreciation. Greater perceived body
acceptance by others also directly predicted higher body appreciation.
One contribution of the current study was the examination of everyday activities,
including participation in sports and hobbies, as predictors of positive body image. Contrary
to expectations, neither participation in sports or hobbies was found to be significantly related
to body appreciation. It may be that the full range of activities relevant to women’s body
appreciation was not captured adequately in this study. It is also possible that women’s earlier
experiences with sports and other engaging activities may be more important for current body
appreciation. Young women’s participation in sports during childhood and adolescence have
previously been shown to be a stronger predictor of body image concerns than current
activity levels (Slater & Tiggemann, 2006). Nevertheless, the current study did find that
engagement in sports and physical activity was related to lower self-objectification, in accord
with a previous study showing an association between adolescent girls’ participation in
organised sports and lowered self-objectification one year later (Slater & Tiggemann, 2012).
Greater sports and physical activity participation also indirectly influenced body appreciation
via lowered levels of self-objectification, in accord with Tiggemann et al.’s (2014) test of the
embodiment model of positive body image for female belly dance participants.
The current study also examined the relationship between body appreciation and
another type of everyday activity, namely media consumption, which surprisingly has
received minimal previous research attention. The present study’s finding that women who
reported that they consumed more appearance media also reported lower body appreciation
36
parallels the large amount of evidence demonstrating negative effects of exposure to
appearance media on body image disturbance (Grabe et al., 2008; Groesz et al., 2002).
Women’s exposure to both appearance and non-appearance media was related, in opposite
directions, to self-objectification, social comparison and thin-ideal internalisation, and also
influenced body appreciation via these processes. The current study’s finding of an indirect
effect of non-appearance media on body appreciation is novel. Based on these findings,
future research investigating whether watching news, documentaries or other types of non-
appearance media sources may be protective for body appreciation is warranted. More
generally, future studies may wish to pay particular attention to how internet-based media
impacts positive body image, given that the internet is the most common source of media
exposure for contemporary young women (Bair, Kelly, Serdar, & Mazzeo, 2012).
Our examination of potential predictors of body appreciation included the
psychological variables of perceived body acceptance by others, self-compassion and
autonomy. Results indicated that greater perceived body acceptance and self-compassion (but
not autonomy) were associated with greater body appreciation. As shown in previous samples
(Andrew et al., 2015b; Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh et al.,
2012), women who perceived more acceptance regarding shape and weight from those
closest to them also reported greater respect and appreciation for their body. The positive
association between self-compassion and body appreciation also replicates previous findings
(Albertson et al., 2014; Wasylkiw et al., 2012). Self-compassion might be particularly
relevant in predicting body appreciation because the self-acceptance and non-judgemental
stance associated with self-compassion should translate to greater acceptance of one’s own
appearance. A recent study found that women who engaged in self-compassion meditation
training reported increased body appreciation compared to a control condition (Albertson et
al., 2014). Albertson et al. (2014) suggested that self-compassion training may operate by
37
allowing women to be less critical of their body, to increase awareness of body diversity and
the consequences of comparisons, and to be more mindful of narrow appearance ideals,
suggestions which are all closely linked to decreasing the appearance processing mediators
tested in the present study.
The current study investigated whether self-objectification, social comparison and
thin-ideal internalisation would act as mediating mechanisms in the relationships between
potential predictors and body appreciation. As expected, reduced levels of self-
objectification, social comparison and thin-ideal internalisation were themselves related to
higher levels of body appreciation. Conceptualising these proposed mediators as indicators of
appearance processing, the integrated model indicated that consuming less appearance
focussed media and greater non-appearance media, and self-compassion predicted greater
body appreciation via less engagement in appearance processing. Taken together, these
findings replicate and expand the small number of explanatory mechanisms that have been
tested within models of positive body image. In particular, the findings of the current study
demonstrate a mediating role for social comparison in the prediction of body appreciation, a
finding previously only shown in adolescent girls (Andrew et al., 2015b). They also highlight
internalisation of the thin ideal as a new mediating pathway.
The results of the current study have a number of practical implications. Although not
individually associated with body appreciation, women’s participation in sports and physical
activity did influence their body appreciation via reduced self-objectification. This finding
supports previous recommendations to encourage women and girls to engage in physical
activities that emphasise body function as opposed to appearance (Tiggemann et al., 2014;
Tylka, 2012). Results also suggest that increased interest in and exposure to non-appearance
media, such as documentaries, may be another step that might foster body appreciation. This
may prove a less challenging task than attempting to reduce exposure to the more pervasive
38
appearance-based media (Levine & Chapman, 2011). Finally, interventions might consider
targeting what we have broadly termed appearance processing to assist in the promotion of
body appreciation. This would involve consciously rejecting the thin ideal and working to not
monitor or compare one’s outward appearance with others. This strategy might be a
component of the “protective filtering” (Wood-Barcalow et al., 2010) which has been shown
to be important for positive body image in qualitative studies (Frisén & Holmqvist, 2010;
Holmqvist & Frisén, 2012; Wood-Barcalow et al., 2010). In addition, a recent dissonance-
based intervention with adolescent girls that included rejection of the thin ideal demonstrated
improvements in body appreciation (Halliwell, Jarman, McNamara, Risdon, & Jankowski,
2015).
There are several limitations of the current study that should be acknowledged. First,
our sample was limited to young, mainly Caucasian college women in Australia, and
therefore findings may not generalise to other populations in other settings. Future research
should sample more diverse participants in terms of age, ethnicity and educational
background. Second, although we investigated a range of potential predictors, there are other
potentially important variables not examined here. Social aspects of women’s lives may be
important in predicting positive body image, such as the types of conversations they engage
in with their friends. Our measures of activities and media consumption were also specifically
constructed for the current study and likely do not encompass all potentially relevant
activities or media forms.
Finally, while we have conceptualised the variables tested in the current study as
predictors of body appreciation, the data are of a cross-sectional nature and cannot
demonstrate causality. However, it is likely that the observed relationships are bi-directional.
For example, while decreased consumption of media containing appearance ideals may
strengthen body appreciation, it is also possible that individuals with greater body
39
appreciation would consciously limit their exposure to such media, which might then serve to
further foster body appreciation. This type of reciprocal relationship involving bi-directional
shaping and strengthening of positive body image has been noted as a specific feature of
positive body image (Tylka, 2011, 2012; Wood-Barcalow et al., 2010). Longitudinal research
over some time (e.g., from adolescence through to adulthood) is necessary in order to
empirically demonstrate the nature of these relationships.
Despite the limitations, the current study has made an important start on investigating
a range of potential predictors and mechanisms of positive body image. Taken together, the
results suggest that greater participation in sports, consumption of non-appearance media,
perceived body acceptance by others, self-compassion and autonomy may play a role (either
directly or indirectly) in promoting body appreciation in young women. On the other hand,
greater consumption of appearance focused media and engagement in appearance processing
were shown to be related to lower levels of body appreciation. Overall, the results contribute
to our understanding of factors that influence positive body image in young women, and in so
doing, identify a number of potential points for intervention.
40
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http://dx.doi.org/10.1016/j.eatbeh.2014.12.009
Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: Item
refinement and psychometric evaluation. Body Image, 12, 53-67. doi:
http://dx.doi.org/10.1016/j.bodyim.2014.09.006
Wasylkiw, L., MacKinnon, A. L., & MacLellan, A. M. (2012). Exploring the link between
self-compassion and body image in university women. Body Image, 9, 236-245. doi:
10.1016/j.bodyim.2012.01.007
Wood-Barcalow, N. L., Tylka, T. L., & Augustus-Horvath, C. L. (2010). “But I like my
body”: Positive body image characteristics and a holistic model for young-adult
women. Body Image, 7, 106-116. doi: 10.1016/j.bodyim.2010.01.001
49
CHAPTER 3: Study 2 – Health Outcomes in Women
Positive Body Image and Young Women’s Health: Implications for Sun Protection,
Cancer Screening, Weight-Loss and Alcohol Consumption Behaviours
Rachel Andrew, Marika Tiggemann, and Levina Clark
School of Psychology, Flinders University, South Australia
Corresponding author: Rachel Andrew, School of Psychology, Flinders University, GPO
Box 2100, Adelaide 5001, South Australia, Australia. Email:
Funding: This research received no specific grant from any funding agency in the public,
commercial or non-for-profit sectors.
Statement of co-authorship:
All authors were involved in the formulation of the study concept and design. Rachel Andrew
collected the data, completed the data analysis and the initial draft of the manuscript. Marika
Tiggemann and Levina Clark edited multiple revisions of the manuscript.
This manuscript has been published as:
Andrew, R., Tiggemann, M., & Clark, L. (2016). Positive body image and young women’s health:
Implications for sun protection, cancer screening, weight-loss and alcohol consumption behaviours.
Journal of Health Psychology, 21, 28-39. doi: 10.1177/1359105314520814
50
Abstract
The study examined the link between positive body image and a range of health behaviours.
Participants were 256 women who completed an online questionnaire measuring body
appreciation, body dissatisfaction, sun protection, cancer screening, seeking medical
attention, weight-loss behaviour and alcohol and tobacco consumption. Results indicated that
body appreciation was positively related to sun protection, skin screening and seeking
medical attention and negatively related to weight-loss behaviour. Body appreciation
explained unique variance, over and above body dissatisfaction, in sun protection, skin
screening and weight-loss behaviour. These results have implications for interventions to
improve adherence to health behaviours.
Keywords: body appreciation, cancer, health behaviour, sun protection, women’s
health
51
Body image has been conceptualised as a complex and multidimensional construct
that has the ability to influence quality of life, as well as affective, cognitive and behavioural
functioning (Pruzinsky & Cash, 2002). Despite the broad understanding of body image as a
multi-faceted concept, theory and research in the body image field have previously been
pathology focused (Williams, Cash, & Santos, 2004), and has concentrated on negative
aspects of body image (Tylka, 2011). In particular, body dissatisfaction had been the major
focus (Grogan, 1999). This focus has meant that the multi-faceted nature of body image has
not been acknowledged (Pruzinsky & Cash, 2002). More specifically, there has been little
research on the positive aspects of body image (Frisén & Holmqvist, 2010).
Broadly defined, positive body image refers to the love, respect, acceptance, and
appreciation held for one’s body (Tylka, 2011). Having positive body image allows
individuals to accept all aspects of their body, even those which are contrary to media-
portrayed ideals, and to appreciate the functions their body performs for them. Such
individuals feel confident and happy with their body, and treat their body with care and
attention (Tylka, 2012). Importantly, this construct is argued to be more than just the
presence of low negative body image (Tylka, 2011), or the mere absence of body
dissatisfaction (Wood-Barcalow, Tylka, & Augustus-Horvath, 2010). The small amount of
literature examining the general construct of positive body image suggests that positive body
image is associated with variables beyond body satisfaction such as optimism and self-esteem
(e.g., Williams et al., 2004).
Until recently, research examining positive body image has been hampered by the
absence of any reliable and valid measurement tool. Recognition of the need to operationalise
positive body image beyond a lack of body dissatisfaction led to the construction of the Body
Appreciation Scale (BAS) by Avalos, Tylka and Wood-Barcalow (2005). This scale has now
been used in a small but growing number of empirical studies. Body appreciation has been
52
shown to be related positively to self-esteem (e.g. Lobera & Ríos, 2011) and self-compassion
(Wasylkiw, MacKinnon, & MacLellan, 2012), which refers to an attitude of kindness and
caring towards oneself (Neff, 2003). A positive relationship has also been found with
perceived social support and acceptance within personal relationships (Augustus-Horvath &
Tylka, 2011). Negative associations have been reported between body appreciation and self-
objectification (Augustus-Horvath & Tylka, 2011), which is the internalisation of an
observer’s perspective of the body (Fredrickson & Roberts, 1997), as well as with having a
non-anxious relationship with one’s God (Homan & Cavanaugh, 2013).
In her review of positive body image theorizing and research, Tylka (2011) suggested
that future research should examine more tangible real-world outcomes, and in particular,
how positive body image relates to attentiveness to the body and detection of disease. As yet,
there has been no research investigating health-related outcomes of positive body image
(operationalised as body appreciation) outside of the eating realm. Here, positive body image
has been related to an intuitive eating (i.e., eating in response to internal physiological cues,
Tribole & Resch, 1995; Tylka, 2006) style (Augustus-Horvath & Tylka, 2011; Avalos &
Tylka, 2006), and negatively related to drive for thinness (Langdon & Petracca, 2010), eating
disorder symptomology (Avalos et al., 2005) and engaging in weight-loss-related
conversations with friends (Wasylkiw & Butler, 2013). Thus, this study aimed to investigate
a broader range of health-related outcomes that could potentially result from positive body
image. An understanding of the role (if any) that positive body image plays in specific health
behaviours will not only assist in clarifying the theoretical conceptualisation of positive body
image, but may also benefit interventions and initiatives that attempt to increase health
behaviour compliance.
There are many health-promotion campaigns, programs and policies (in Australia, and
elsewhere) that are designed to influence particular modifiable health behaviours in the
53
population (Australian Institute of Health and Welfare, 2012). Such campaigns target either
increases in health-promoting behaviours or decreases in health-compromising behaviours, or
both. This study focused on health behaviours that feature in contemporary Australian health
campaigns. In particular, the health-promoting behaviours of sun protection, and skin, breast
and cervical cancer screening, and the health-compromising behaviours of unhealthy weight-
loss behaviour and alcohol and tobacco consumption were examined as possible outcomes of
positive body image. In addition, seeking medical attention when needed was included as a
more general measure of engagement in health and because body image has been previously
implicated as a barrier to engaging in medical care (Alegria Drury & Louis, 2002).
Australia has the highest incidence of skin cancer in the world (International Agency
for Research on Cancer, 2008), with skin cancer accounting for approximately 80 per cent of
all newly diagnosed cancers each year (Cancer Council Australia, 2012a). As a result,
different behaviours which provide protection from harmful ultraviolet radiation (UVR) are
encouraged through specific campaigns, for example the ‘Slip, Slop, Slap, Seek, Slide’
(Cancer Council Australia, 2012b) and the ‘No tan is worth dying for’ (Cancer Council
Australia, 2012c) campaigns. Although some links between tanning behaviour and higher
body satisfaction (Yoo & Kim, 2012) and weight concern (O'Riordan et al., 2006) have been
reported, minimal attention has been directed toward other sun protection behaviours such as
hat or sunscreen use.
A related health behaviour is skin screening for moles and other abnormalities, which
has been targeted by Australian health-promotion initiatives. In Australia, people are
encouraged to scan for various cancers, including regularly inspecting all skin areas for
suspicious looking moles (Cancer Council Australia, 2007). A cervical cancer screening
program for women between the ages of 18 and 69 recommends Papanicolaou (pap) tests
every two years (Department of Health and Ageing, 2009). Programs for mammogram breast
54
screenings presently target women aged 50 to 69 years, although younger women are also
encouraged to be vigilant for any breast abnormalities (Department of Health and Ageing,
2012).
As noted by Ridolfi and Crowther (2012) in their review of body image disturbance
and cancer screening, screening behaviours are especially pertinent to body image, as they
require inspection (personally, and sometimes from a medical professional) of the body.
Here, links between body dissatisfaction and discomfort (Chait, Thompson, & Jacobsen,
2009; Jensen & Moriarty, 2008; Risica et al., 2008) and lower frequency of skin
examinations have been reported. There is less research examining body image disturbance
and breast and cervical cancer screening. One study (Chait et al., 2009) found no association
between body disturbance and women’s breast screening behaviour or intention, while
another (DeMaria, Hollub, & Herbenick, 2011) reported no association with gynaecological
exam behaviour. More generally, however, Clark et al. (2009) reported that body image
concern was one of the most frequently reported barriers to avoiding breast, cervical or
colorectal screening.
Unhealthy weight-loss practices and alcohol and tobacco consumption are behaviours
that can compromise health and have been a focus of health initiatives in Australia. Due to
the increasing incidence of overweight and obesity in Australia, current dietary guidelines
advocate for healthy weight management strategies (National Health and Medical Research
Council, 2013). However, not all weight-loss strategies are healthy, for example, the diet
industry promotes a variety of products such as shakes and pills (Ogden, 2003). Many
previous studies have shown associations between body dissatisfaction and unhealthy weight-
loss strategies and dieting (see Stice & Shaw, 2002).
Alcohol and tobacco consumption have been shown to be leading causes of disease
and death in Australia, with tobacco consumption the largest risk factor for cancer-related
55
burden of disease (Begg, Vos, Barker, Stanley, & Lopez, 2008). Associations between body
dissatisfaction (Kendzor, Adams, Stewart, Baillie, & Copeland, 2009; Stice & Shaw, 2003) or
weight preoccupation (Clark et al., 2005) with cigarette smoking have been reported. One
focus area of Australian alcohol-related guidelines is single occasion excessive alcohol use
(or ‘binge-drinking’), and reducing risk of injury when binge-drinking (National Health and
Medical Research Council, 2009). Binge drinking has itself been found to be associated with
body dissatisfaction (Nelson, Lust, Story, & Ehlinger, 2009).
In sum, the major aim of the present study was to examine a range of diverse health
behaviour outcomes of positive body image, which to our knowledge is the first study to do
so. Relationships were also compared with body dissatisfaction, the most common measure
of (negative) body image. It was hypothesised that body appreciation would be positively
related to the health-promoting behaviours and negatively related to the health-compromising
behaviours. Furthermore, body appreciation was predicted to explain additional unique
variance in health behaviours over and above that explained by body dissatisfaction.
Method
Participants
Participants were 256 women aged 18-29 years (M = 20.11, standard deviation (SD) =
3.11) who were students at an urban university in South Australia. Participants’ mean body
mass index (BMI) was 23.50 (SD = 6.01), which falls within the ‘normal range’ (World
Health Organization, 2015). The majority of participants identified as Caucasian or White
(89.1%), with 8.5% Asian, 0.4% Aboriginal or Torres Strait Islander, 0.4% African, and 1.6%
‘other’.
Materials
56
Participants completed an online questionnaire which contained the measures listed
below, and was approved by the relevant institutional ethics committee. Participant consent
was indicated by completion of the questionnaire.
Background information. Participants were asked their age, height, weight, and
ethnicity. Body mass index (BMI) was then calculated as weight [kg] / height2 [m
2].
Positive body image. Positive body image, operationalised as body appreciation, was
assessed by the Body Appreciation Scale (BAS) of Avalos et al. (2005) which measures the
appreciation, acceptance, respect, and attention given to one’s body. Participants rate 13
items on a 5-point Likert scale (from 1 = never, to 5 = always). Exemplar items are “Despite
my flaws, I accept my body for what it is”, and “I am attentive to my body’s needs”.
Responses are averaged, and range from 1 to 5, with higher scores reflecting greater body
appreciation. The BAS has been found to have a unidimensional factor structure, good
internal reliability (α = .91-.94), three week test-rest reliability (r = .90), and convergent
validity with samples of U.S. college women (Avalos et al., 2005). In a previous study with
Australian women (M age = 39.93 years, SD = 13.27), the BAS was found to have high
internal reliability (α = .90, Tiggemann & McCourt, 2013). For the present sample, the scale
was also found to have high internal reliability (α = .93).
Body dissatisfaction. Body dissatisfaction was measured by the Body Areas
Satisfaction Scale (BASS) of Brown, Cash and Mikulka (1990), and Cash (2000).
Participants rate on a 5-point Likert scale how dissatisfied or satisfied they are with their
appearance overall, and with eight specific areas (e.g., face) or elements (e.g., muscle tone) of
their body (from 1 = very dissatisfied to 5 = very satisfied). All items were reverse scored,
summed and averaged to create a measure of body dissatisfaction. For women, the BASS has
been reported to have good one month test-retest reliability (Cash, 2000), internal consistency
(α = .82, Cash, Fleming, Alindogan, Steadman, & Whitehead, 2002), and good incremental
57
validity (Giovannelli, Cash, Henson, & Engle, 2008). For the present sample, internal
reliability was acceptable (α = .80).
Sun protection. Five questions related to sun protection were adopted from the
Cancer Council Australia’s National Sun Protection Survey (see Dobbinson et al., 2008).
These questions examined specific behaviours such as wearing sunscreen and staying in the
shade during peak UV hours in summer. Participants rated how often they performed each
sun protection behaviour (from 1 = never to 5 = always). The five items were summed to
create a total sun protection behaviour score ranging from 5 to 25. Internal reliability for this
scale fell just short of acceptable (α = .64) in the current sample of women.
Cancer screening. There were three forms of cancer screening, those for skin, breast
and cervical cancer. Skin screening was assessed with two questions regarding checking for
sun spots and moles regularly, and getting moles and sun spots checked by a health
professional (r = .52, p < .001), which were summed and averaged to create a skin screening
measure. Similar questions assessed checking for breast lumps (r = .34, p < .001). A single
item asked participants whether they receive pap tests when they are required. Participants
rated all items on a 5-point Likert scale (1 = never to 5 = always), with higher scores
reflecting more participation in the health behaviour.
Medical attention. One additional question asked whether participants see a doctor
when needed and assessed general engagement in health which was rated on 5-point Likert
scale (from 1 = never to 5 = always).
Weight-loss behaviours. Participants were asked to rate the extent to which they
“Use weight-loss shakes, supplements or pills”, and had “Been on a diet in order to lose
weight” on a 5-point Likert scale (from 1 = never to 5 = always). These two items were
moderately correlated (r = .53, p < .001), and were summed and averaged to create a single
measure of ‘weight-loss behaviours’.
58
Alcohol consumption. Participants’ consumption of alcohol at risky levels was
assessed using two questions from the Alcohol Use Disorders Identification Test (AUDIT)
Alcohol Screen (Commonwealth Department of Veterans' Affairs, 2003). The questions were
“How many standard drinks do you have on a typical day when you are drinking?” (from ‘1
or 2’ to ‘10 or more’) and “How often do you have six or more standard drinks on one
occasion?” (from ‘never’ to ‘daily or almost daily’). Reponses for the two questions were
standardised and summed to create one risky alcohol consumption score.
Tobacco consumption. Participants were asked two questions regarding their tobacco
use from the National Drug Strategy Household Survey (Australian Institute of Health and
Welfare, 2011). First, they were asked whether or not they smoke cigarettes, and second, with
what frequency (‘Daily’, ‘At least weekly (but not daily)’, ‘Less often than weekly’, ‘Not at
all’).
Results
Body Appreciation and Health-Promoting Behaviours
Descriptive statistics for body image and health behaviour variables are displayed in
Table 1. The mean score for sun protection behaviours indicates that on average, participants
‘sometimes’ performed behaviours such as wearing sunscreen and staying in the shade. As
can be seen in Table 2 which displays the correlations between positive body image (body
appreciation) and health behaviours, body appreciation was significantly positively related to
sun protection.
Participants on average performed cancer screening behaviours between ‘rarely’ and
‘sometimes’, and as can be seen in Table 2, the correlations between body appreciation and
cancer screening behaviours were all positive. However, only the correlation with skin
screening reached statistical significance.
59
Table 1
Descriptive Statistics of Body Image Variables and Health Behaviours
For medical attention, participants reported that they sought medical attention when
they needed ‘often’, and as predicted, body appreciation was significantly positively related
to this behaviour.
Body Appreciation and Health-Compromising Behaviours
Participants on average reported performing weight-loss behaviours ‘rarely’. As
predicted, body appreciation was significantly negatively correlated with weight-loss
behaviours.
For alcohol consumption, the median category for the number of standard alcoholic
drinks consumed when drinking was ‘3 or 4’ alcoholic drinks (24.8%). The median category
for the frequency with which participants consumed six or more standard alcoholic drinks on
M SD Range
Body appreciation 3.23 0.79 1 - 5
Body dissatisfaction 2.92 0.67 1 - 5
Health-promoting behaviours
Sun protection 14.54 3.73 5 - 25
Screening behaviours
Skin screening 2.32 0.98 1 - 5
Breast screening 2.03 0.96 1 - 5
Pap tests 2.88 1.74 1 - 5
Medical attention 3.81 1.14 1 - 5
Health-compromising behaviours
Weight-loss behaviours
Alcohol consumption
Cigarette smoking
2.01
0.13
1.93
1.04
1.77
0.26
1 - 5
-4 - +4
1 - 2
60
single occasions was “less than monthly” (30.6%). Body appreciation was not found to be
significantly related to total alcohol consumption.
Table 2
Correlations between Body Appreciation, Body Dissatisfaction and Health Behaviours
The vast majority of participants did not smoke cigarettes (N = 232), with 91.6%
indicating they do not smoke cigarettes at all, 4.4% smoked cigarettes less often than weekly,
0.8% smoked cigarettes at least weekly, and only 3.2% smoked daily. As seen in Table 2,
smoking status was not significantly correlated to body appreciation. Although body
appreciation was found to be higher in non-smokers (M = 3.24, SD = 0.76) than smokers (M
= 3.05, SD = 0.91), an independent samples t-test revealed this difference was not significant,
t(242) = -0.99, p = .32.
Body appreciation Body dissatisfaction
r r
Health-promoting behaviours
Sun protection .17** -.09
Screening behaviours
Skin screening .16* -.14*
Breast screening .10 -.12
Pap tests .08 -.05
Medical attention .18** -.20**
Health-compromising behaviours
Weight-loss behaviours -.41*** .35***
Alcohol consumption -.09 .14*
Cigarette smoking .06 -.04
Multiple R2 .239*** .215***
*p < .05. ** p < .01. *** p < .001.
61
Relative Contribution of Body Appreciation to Health Behaviours
Participants’ body appreciation was found to be negatively correlated with their body
dissatisfaction as would be expected, r = -.80, p < .001. Table 2 displays the correlations
between body dissatisfaction and the various health behaviours. As can be seen, the pattern of
correlations for body dissatisfaction was somewhat different from that for body appreciation.
In particular, while both variables were related (in the opposite direction) to skin screening,
seeking medical attention and weight-loss behaviours, only body appreciation was related to
sun protection, and only body dissatisfaction was related to alcohol consumption.
To formally test whether positive body image contributed unique variance, over and
above body dissatisfaction, to any of the health behaviours, a series of hierarchical multiple
regressions were carried out for each of the health behaviours. In each hierarchical multiple
regression, body dissatisfaction was entered in Step 1, and body appreciation was entered in
Step 2, to predict the health behaviour. The results of these analyses are provided in Table 3,
with R2
change and Fchange values in Step 2 indicating whether or not body appreciation offered
additional prediction over and above body dissatisfaction.
As can be seen in Table 3, body appreciation explained significant unique variance in
sun protection, skin screening and weight-loss behaviours. That is, body appreciation offered
predictive value in these three health behaviours, over and above body dissatisfaction. The
only initially significant behaviour for which body appreciation did not explain unique
variance was seeking medical attention.
62
Table 3
Summary of Hierarchical Multiple Regression Analyses Predicting Health Behaviours from
Body Appreciation and Body Dissatisfaction
Discussion
This study examined the relationship between positive body image and a range of
health-promoting and health-compromising behaviours. While negative body image or body
dissatisfaction has previously been found to be associated with some health behaviours, this
was the first study to investigate how positive body image related to health behaviours
beyond eating. Specifically, body appreciation was found to be positively related to sun
protection, skin screening and seeking medical attention, and negatively related to weight-
loss behaviours. On the other hand, body appreciation was not significantly related to breast
Step 1 Step 2
Body dissatisfaction Body appreciation
R2 F R
2change Fchange
Health-promoting behaviours
Sun protection .008 1.83 .034 8.36**
Screening behaviours
Skin screening .018 4.28* .018 4.48*
Breast screening .015 3.69 .003 0.77
Pap tests .003 0.82 .008 1.92
Medical attention .044 11.07** .004 0.99
Health-compromising behaviours
Weight-loss behaviours .118 32.18*** .049 14.15***
Alcohol consumption .021 4.54* .002 0.37
Cigarette smoking .001 0.33 .000 0.00
*p < .05. ** p < .01. *** p < .001.
63
screening, pap tests or alcohol-related or smoking behaviours. The finding for weight-loss
behaviours confirms previous results demonstrating a negative association between positive
body image and unhealthy eating behaviour (e.g., Augustus-Horvath & Tylka, 2011; Avalos
& Tylka, 2006; Avalos et al., 2005; Langdon & Petracca, 2010). However, the relationships
found between body appreciation and other health behaviours are novel.
This study found links between body appreciation and both skin screening and sun
protection which have not previously been reported. Importantly, the results also
demonstrated that body appreciation contributed unique variance in sun protection and skin
screening, over and above that previously reported for body dissatisfaction (Chait et al., 2009;
Risica et al., 2008). Given that Australia has the highest incidence of skin cancer in the world
(International Agency for Research on Cancer, 2008) and that skin cancers account for the
overwhelming majority of new cancers diagnosed in Australia every year (Cancer Council
Australia, 2012a), these findings suggest a potential avenue for interventions and campaigns
specifically aimed at young women to increase sun protection behaviours and screening for
skin cancer. Such campaigns might choose to focus on the benefits of sun protection and skin
screening for the body, as opposed to emphasising appearance-based negative consequences
of not engaging in these behaviours (e.g., developing wrinkles).
Although not significant, the correlations between body appreciation and breast
screening and receiving pap tests lay in the predicted direction. It may be that breast
screening is not an appropriate measure in a young sample given that recommendations are
strongly geared toward women aged 40 years and over (Department of Health and Ageing,
2012). However, no significant relationship between body dissatisfaction and breast
screening in a more diverse sample of older women was reported in a previous study (Chait et
al., 2009). Thus, the lack of significant association may be due to the nature of breast
screening which involves a tactile rather than visual inspection of a relatively small and
64
specific area of the body (Chait et al., 2009). This contrasts with screening for skin
abnormalities which requires close visual attention directed to the whole surface of the body,
consistent with the positive correlation found here between positive body image and skin, but
not breast, screening. Similar to DeMaria et al. (2011), no relationship existed between body
appreciation (or body dissatisfaction) and cervical cancer screening. This study’s findings add
to the small body of work examining cancer screening, but support Ridolfi and Crowther’s
(2012) call for more research in order to make definitive conclusions about the nature of the
relationships between body image and cancer screening behaviours.
More generally, body appreciation was positively related to seeking medical attention
when required, demonstrating a potential role for positive body image in overall motivation
to enhance health. Seeking medical attention is a more global and far-reaching behaviour than
specific cancer screening, and can contribute to the detection and prevention of a range of
diseases. In addition, general practitioners have the ability to encourage regular screening
practices and to promote a whole range of health behaviours in people who seek professional
advice for medical problems (Dobson et al., 2012).
The results support previous links reported between body dissatisfaction and alcohol
consumption (Littleton, Radecki Breitkopf, & Berenson, 2005; Nelson et al., 2009), but
interestingly no relationship with body appreciation was found. Alcohol intake is an
important health issue in Australia, and is the focus of various campaigns as well as specific
health guidelines. Our results suggest that targeting body dissatisfaction in health initiatives
that aim to reduce risky alcohol consumption may be useful. Contrary to some previous
findings (Clark et al., 2005; Kendzor et al., 2009; Stice & Shaw, 2003), the present study
found no links between body image and cigarette smoking. However, this result is not
surprising given the very low proportion of smokers in the present sample (8.4%).
65
In general, while body appreciation and body dissatisfaction were correlated with
each other and were found to be related to some of the same variables, the pattern of
correlations was not the same. In particular, the overall pattern suggests that positive body
image might be more related to health-promoting behaviours, while negative body image
might be more related to health-compromising behaviours. Future research might usefully
investigate this interesting proposition. In addition, the regression analyses indicated that
body appreciation was able to explain unique variance in some of the health behaviours,
beyond that explained by body dissatisfaction. The unique contribution of positive body
image to sun protection, skin screening and weight-loss behaviours presents convincing
evidence that body appreciation does play a role in these health behaviours. Nevertheless,
further research needs to comprehensively address the conceptual difference between positive
body image and the absence of body dissatisfaction by examining multiple measures of the
two constructs and how they relate to a range of social, health and well-being variables.
This study’s findings have some practical implications. Given that body
dissatisfaction is now viewed as normative among young women (Rodin, Silberstein, &
Striegel-Moore, 1985) and that they are confronted with flawless media images portraying
the thin ideal on virtually a daily basis (Levine & Chapman, 2011), it is possible that
strategies that seek to enhance positive body image may prove more successful than
strategies that attempt to reduce body dissatisfaction. In particular, if girls and women can be
explicitly encouraged to accept and appreciate all parts of their body, including its flaws, they
should be better able to withstand media pressures.
One way that women and girls might actively learn to develop their appreciation for
their bodies is by engaging in metacognitive acceptance techniques which have begun to
show some success for general body image (Atkinson & Wade, 2012). Such techniques
emphasise that thoughts, feelings and physical sensations are to be observed and experienced
66
but not judged or actively modified (Baer, 2003). Thus, they may serve to prevent or
ameliorate women’s tendency to engage in social comparison or rumination about their
appearance. More broadly, engaging in mindful meditation may assist in the accurate and
early detection of bodily needs or changes (Bishop et al., 2004). Another way that women
and girls might increase body appreciation is to participate in embodying activities, that is,
activities in which the mind and body are interconnected (Piran, 2002). These include
organised sports and other physical pursuits such as rock climbing or yoga, which are not
self-objectifying (e.g. Prichard & Tiggemann, 2008), and are postulated as potential
precursors to positive body image (Menzel & Levine, 2011). Encouraging women to discuss
exercise and physical activity with peers may also foster positive body image, as those
women who engage in more exercise (as opposed to appearance) related conversations have
been shown to hold more functional (as opposed to objectifying) views of their body
(Wasylkiw & Butler, 2013).
Taken together, the findings allow us to add women’s physical health to the list of
potential benefits associated with positive body image. Accordingly, they suggest that
targeting positive body image might be one way to effect tangible improvements in women’s
health. Thus, public health and other interventions designed to modify health-related
behaviours, in particular health-promoting behaviours, might usefully incorporate positive
body image into their protocols. Public health campaigns commonly deliver messages about
the harmful consequences of an unhealthy behaviour (known as fear appeals) rather than
offering a positive behaviour as an alternative (Rice & Atkin, 2001). Reframing these in the
positive direction might improve their effectiveness.
There are some limitations to this study that should be noted. First, the sample
comprised mainly young Caucasian university students, and so results may not generalise to
other groups of women. Second, the self-report nature of the questionnaire may also have
67
limited participants’ ability to accurately remember and report the degree to which they did or
did not perform health behaviours. Third, the just below acceptable internal reliability for the
sun protection measure means that results for this variable should be viewed with caution.
Finally, the cross-sectional design means that it is not possible to determine causal or
temporal relationships between the different variables. Although as suggested by Tylka
(2011), it is more logical to treat health behaviours as an outcome of possessing positive body
image, it is also theoretically possible that engaging in healthy behaviours could lead to the
development of positive body image. Alternatively, there might be a third variable that
explains both. Future research should employ longitudinal designs that track the development
of both positive body image and health-related behaviours over some time for a more
definitive casual conclusion.
Despite its limitations, to our knowledge this is the first study to examine non-eating
health-related outcomes of positive body image. In particular, the results demonstrate that
positive body image is linked to the health-promoting behaviours of sun protection, skin
screening and seeking medical attention, and negatively associated with the health-
compromising behaviour of unhealthy weight-loss. These findings have both theoretical and
practical implications: first, in expanding the scope of positive body image; and second; in
identifying a new target for promoting healthy behaviours.
68
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CHAPTER 4: Study 3 – Protection Against the Thin Ideal
The Protective Role of Body Appreciation against Media-Induced Body Dissatisfaction
Rachel Andrew, Marika Tiggemann, and Levina Clark
School of Psychology, Flinders University, South Australia
Corresponding author: Rachel Andrew, School of Psychology, Flinders University, GPO
Box 2100, Adelaide 5001, South Australia, Australia. Email:
Statement of co-authorship:
All authors were involved in the formulation of the study concept and design. Rachel Andrew
collected the data, completed the data analysis and the initial draft of the manuscript. Marika
Tiggemann and Levina Clark edited multiple revisions of the manuscript.
This manuscript has been published as:
Andrew, R., Tiggemann, M., & Clark, L. (2015). The protective role of body appreciation against
media-induced body dissatisfaction. Body Image, 15, 98-104. doi: 10.1016/j.bodyim.2015.07.005
77
Abstract
This study aimed to examine the protective role of positive body image against negative
effects produced by viewing thin-idealised media. University women (N = 68) completed trait
measures of body appreciation and media protective strategies. At a subsequent session,
participants viewed 11 thin-ideal advertisements. Body dissatisfaction was assessed before
and after advertisement exposure, and state measures of self-objectification, appearance
comparison, and media protective strategies were completed. Results indicated that body
appreciation predicted less change in body dissatisfaction following exposure, such that
participants with low body appreciation experienced increased body dissatisfaction, while
those with high body appreciation did not. Although state appearance comparison predicted
increased body dissatisfaction, neither state self-objectification nor appearance comparison
accounted for body appreciation’s protective effect. Trait and state media protective strategies
positively correlated with body appreciation, but also did not account for body appreciation’s
protective effect. The results point to intervention targets and highlight future research
directions.
Key words: body appreciation, positive body image, self-objectification, appearance
comparison, body dissatisfaction, media protective strategies
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Introduction
The body image field has recently experienced a shift from a strong emphasis on
negative aspects of body image to a broader focus and understanding of different elements of
body image (Tylka, 2011). Specifically, researchers have begun to examine positive body
image and the ways in which it may foster well-being. Positive body image can be defined as
a foundation of love, respect, appreciation, and acceptance of the appearance and
functionality of one’s body (Wood-Barcalow, Tylka, & Augustus-Horvath, 2010). Positive
body image is conceptualised as more than merely the absence of body dissatisfaction (Tylka,
2011; Tylka & Wood-Barcalow, 2015; Wood-Barcalow et al., 2010), and is most commonly
operationalised as body appreciation (Avalos, Tylka, & Wood-Barcalow, 2005). Previous
research demonstrates that body appreciation correlates with a broad range of positive well-
being indices including self-esteem (e.g., Avalos et al., 2005), adaptive coping (Avalos et al.,
2005; Lobera & Ríos, 2011), self-compassion (Wasylkiw, MacKinnon, & MacLellan, 2012)
and optimism (Avalos et al., 2005; Dalley & Vidal, 2013).
Tylka (2011) sets out a number of core characteristics of positive body image based
on findings from qualitative and quantitative research. One identified characteristic is
“protective filtering” (Wood-Barcalow et al., 2010), which involves schema activation that
allows negative body-related information to be rejected and positive information to be
accepted. Negative information can potentially be received from a variety of sources,
including family members or peers, but the most likely source is the mass media, a major
transmitter of sociocultural messages regarding unattainable standards of appearance, in
particular the thin ideal (Grabe, Ward, & Hyde, 2008). Both experimental and correlational
research shows that exposure to thin-ideal media images is linked to body dissatisfaction and
disordered eating (for meta-analyses, see Grabe et al., 2008; Groesz, Levine, & Murnen,
2002). One potential strategy to counter the negative effects of media exposure on body
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image is increased media literacy, which Tylka (2012) proposes is an important component of
protective filtering. Media literacy involves critically evaluating the media’s depiction of
appearance ideals, for example, by being aware of portrayed narrow ideals of beauty and the
widespread digital modifications of media images (Levine & Smolak, 2001). People with
positive body image are proposed to be able to better protect their body image from
potentially harmful appearance messages by engaging in protective filtering and media
literacy (Tylka, 2011; Tylka & Wood-Barcalow, 2015).
As yet, only one study has experimentally examined the protective effect of body
appreciation against thin-ideal media exposure. Halliwell (2013) compared the responses of
young women with high and low body appreciation (groups created by median split). For
women high in thin-ideal internalisation, the low body appreciation group reported larger and
more salient appearance-discrepancies (i.e., difference between ideal and actual appearance)
after viewing advertisements with models versus products, relative to the high body
appreciation group. The present study aimed to extend this research by examining whether
body appreciation protects against increases in body dissatisfaction, the construct most
commonly measured in studies of media effects on body image (Grabe et al., 2008), in
response to viewing thin-ideal advertisements. In addition, we conceptualised body
appreciation as a continuous dimension (as opposed to low/high categories, Halliwell, 2013),
in order to assess prediction by degree of body appreciation.
The second aim of the current study was to begin the investigation of possible
mechanisms to explain body appreciation’s protective effects. Specifically, decreased self-
objectification and decreased social appearance comparison were examined for their ability to
account for body appreciation’s protective role against negative effects on body image after
exposure to thin-ideal images. Recent correlational research has shown that body appreciation
is associated with reduced self-objectification and appearance comparison at the trait level
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(Andrew, Tiggemann, & Clark, 2015). We reasoned that women who approach their
appearance with acceptance and appreciation should be less likely to feel the need to compare
and evaluate their appearance to other people when confronted with appearance-based
stimuli. These women should also engage in less state self-objectification because they
respect and appreciate their body, in spite of perceived flaws, and thus do not need to monitor
outward appearance. Thus, lower levels of engagement in self-objectification and appearance
comparison were proposed as explanatory concepts in the protective role played by body
appreciation on body dissatisfaction.
In addition, we wished to explore some more specific protective strategies that
participants may engage in while viewing thin-ideal media images, an important next step, as
suggested by Halliwell (2015). We investigated both strategies that women might use
generally (i.e., trait-level dispositions) and also those that they actually engage in while
viewing thin-ideal images (i.e., state-level strategies). Although there are some measures
assessing general reactions to body-related threats (see Webb, Wood-Barcalow, & Tylka,
2015), there is no existing measure of body image protective strategies against media images.
Thus, we constructed a media-specific measure to examine behavioural and cognitive
techniques related to protective filtering as identified in qualitative positive body image
studies (Tylka, 2011; Wood-Barcalow et al., 2010). Such strategies included being conscious
of the fact that images may have been digitally altered, being aware that the media present
only a narrow view of beauty, and understanding that substantial time and professional
assistance is required for models to look the way they do (Holmqvist & Frisén, 2012; Wood-
Barcalow et al., 2010).
In sum, the present study had two major aims. The first was to determine whether
degree of body appreciation protects against increases in body dissatisfaction after viewing
thin-ideal media images. The second was to begin the examination of potential mechanisms
81
to explain this protective effect, in particular, reduced state self-objectification and
appearance comparison. In addition, more specific strategies that women may engage in
when exposed to thin-ideal media were explored.
Method
Participants
Participants were 68 women aged 18-29 years (M = 20.03, SD = 3.02) who were
students at an urban university in South Australia. Participants’ mean body mass index (BMI)
was 21.76 (SD = 4.43), which falls within the “normal range” according to the World Health
Organization (2015). The majority of participants identified as Caucasian or White (77.9%),
with 17.6% Asian, and 4.5% identifying as “other.”
Measures and Materials
Experimental stimuli. A set of 15 full-page magazine advertisements printed on high
quality photographic paper was presented in a folder to replicate the format of a typical
fashion magazine. In a separate study, this particular set of advertisements led to greater body
dissatisfaction than a set of control advertisements (Tiggemann, Slater, Bury, Hawkins, &
Firth, 2013). There were 11 advertisements representing the thin ideal that contained the face
and at least three-quarters of a thin and attractive female model’s body, plus four product
only advertisements. The advertisements were sourced from common locally-available
Australian fashion magazines such as Cosmopolitan and Vogue.
Body appreciation. Body appreciation was assessed by the Body Appreciation Scale
(BAS) of Avalos et al. (2005) which measures the acceptance, respect, and attention towards
bodily needs and favourable opinions towards one’s body. The 13 items are rated on a 5-point
scale (1 = never, 5 = always). Exemplar items are “Despite my flaws, I accept my body for
what it is,” and “I am attentive to my body’s needs.” Scores are averaged to range from 1 to
5, with higher scores reflecting greater body appreciation. Scores on the BAS have been
82
found to conform to a unidimensional factor structure and demonstrate evidence of internal
reliability (α = .91-.94), 3-week test-rest reliability (r = .90), and convergent validity with
samples of U.S. college women (Avalos et al., 2005). In a previous sample of Australian
women (Tiggemann & McCourt, 2013), scores on the BAS were found to have high internal
reliability (α = .90). This was also the case in the present sample (α = .93).
Trait media protective strategies. A small focus group was conducted with five
young adult women (M age = 24 years) who were university educated, of average socio-
economic status, who indicated that they had positive body image. They were asked to
describe general hypothetical strategies (cognitive, behavioural, and emotional) that they used
to deal with information from the media that could negatively impact on their body image.
Two overarching themes emerged from the focus group discussion. The first theme involved
avoidance and encompassed strategies that the women used to intentionally limit exposure to
media featuring the thin ideal, including limiting reading of fashion magazines and not
paying attention to photos on social media. The second theme involved use of protective
processing strategies and included women reminding themselves that it is a model’s job to
look the way she does and that images are constructed, altered, and manipulated in a number
of ways. On the basis of the focus group, a questionnaire consisting of four strategies for the
theme of media avoidance and eight strategies for the protective processing theme was
constructed. The items were rated on a 5-point Likert scale (1 = strongly disagree, 5 =
strongly agree) and scores were averaged to create media avoidance and protective
processing scales. The internal reliability for the media avoidance subscale was low (α = .36).
However, omitting the one negatively worded item improved internal reliability to a
somewhat higher level for the 3-item scale (α = .50). The internal reliability for the protective
processing subscale was acceptable (α = .72), but slightly increased with the exclusion of the
83
one negatively-worded item (α = .74). Internal reliability for the overall scale’s scores (minus
the two negatively worded items) was acceptable (α = .73). Items are presented in Table 2.
State body dissatisfaction. Participants completed seven Visual Analogue Scales
(VAS, Heinberg & Thompson, 1995) before and after exposure to advertisements. The first
five measured mood (Anxiety, Depression, Happiness, Anger, and Confidence - not analysed
here) and were included to decrease the focus on body dissatisfaction. The last two items
measured Weight Dissatisfaction and Overall Appearance Dissatisfaction. Each scale
consisted of a 100mm horizontal line with end points of “none” and “very much.”
Participants were asked to draw a small vertical line at the point which represents how they
feel at that particular moment for each item. The distance to the nearest millimetre was then
measured from the anchor of “none” to yield a score for each scale out of 100. VAS measures
of body dissatisfaction were used as they are quickly administered, can detect small changes
in state body dissatisfaction (Heinberg & Thompson, 1995), and have been shown to
significantly correlate with the Body Dissatisfaction Subscale of the Eating Disorder
Inventory (Garner, Olmstead, & Polivy, 1983). The two body dissatisfaction VAS scores
were averaged to create a measure of body dissatisfaction. To assess inter-rater reliability, a
subsample (25% of the VAS) was measured by a second independent rater. The two
measurements corresponded exactly on 93% of measurements, with the remaining 7% of
cases within ± 1mm.
State self-objectification. State self-objectification was assessed using the 8-item
state adaptation of the Body Surveillance Subscale of the Objectified Body Consciousness
Scale (McKinley & Hyde, 1996). Following Breines, Crocker and Garcia (2008), the words
“Right now” were placed in front of the statements of the subscale. The items were rated on a
7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), with a midpoint of 4
(neither agree nor disagree). Scores were averaged and higher scores represented higher
84
levels of body monitoring and thinking of one’s body in terms of appearance as opposed to
how it feels. Acceptable internal consistencies (α =.74-.83) were reported for this state
adaption in a previous Australian sample of undergraduate women (Tiggemann & Andrew,
2012). The internal consistency in the present sample fell within this range (α = .82).
State appearance comparison. State appearance comparison was assessed using a
short 3-question measure constructed by Tiggemann and McGill (2004). These questions
assessed the amount of appearance comparison participants engaged in with the models in the
fashion advertisements. They were embedded in other questions regarding focus on products
and creativity of the advertisements. Participants first rated the extent to which they thought
about their appearance while viewing the advertisements on a 7-point scale (1 = no thought at
all, 7 = a lot of thought). The second and third questions asked participants to rate the extent
to which they compared their overall appearance, and specific body parts, to the models in
the advertisements on a 7-point scale (1 = no comparison, 7 = a lot of comparison). The
scores from the three items were summed and averaged. Tiggemann and McGill (2004)
reported high internal consistency in a female undergraduate sample (α = .91), as was the
case in the present sample (α = .92).
State media protective strategies. Participants completed five questions assessing
potential protective strategies actually used to minimise harm on body image from viewing
media images. These items were based on those strategies in the trait measure of media
protective strategies designed for the current study. Participants rated the extent to which they
thought about how: “The advertisements might have been digitally altered to improve
appearance,” “The women in the advertisements may have had their hair and make-up done
by professionals,” “The women in the advertisements were not a true representation of
women in society,” “The women in the advertisements look the way they do because it is
their job” and “The women in the advertisements might not necessarily be healthy or happy,”
85
on a 7-point scale (1 = not a lot of thought at all, 7 = a lot of thought). Internal reliability was
acceptable for the overall 5-item scale (α = .88).
Background information. Participants were asked to provide their age and ethnicity,
and with their consent measurements of weight and height were taken. Body mass index
(BMI) was then calculated as weight [kg] / height2 [m
2].
Procedure
Ethics approval was gained from the relevant institutional ethics board. Participants
gained course credit for their involvement in the current study. As part of another study on
health behaviours (Andrew, Tiggemann, & Clark, 2014), participants completed trait
measures of body appreciation and the created measure of trait media protective strategies.
These measures were collected separately to the experimental session in an attempt to reduce
demand characteristics, as suggested in previous experimental media studies (Mills, Polivy,
Herman, & Tiggemann, 2002). Participants completed the experimental session
approximately eight weeks after trait measures were taken. The study was promoted as
evaluating the effectiveness of advertisements targeted at women. Participants first completed
measures of negative mood and state body dissatisfaction. They were then given a folder
containing the 15 advertisements and viewed each for 45 seconds. To ensure attention was
maintained and to support the cover story, participants were asked to rate two items on the
effectiveness and appeal of each advertisement. Participants then completed state measures of
negative mood and body dissatisfaction, self-objectification, appearance comparison
processing, and media protective strategies. Weight and height were then measured by the
first author. Participants were debriefed via an email following the completion of the whole
study.
86
Results
Change in Body Dissatisfaction
Overall, there was a difference between body dissatisfaction before and after exposure
to the fashion magazine advertisements. A paired-samples t-test confirmed a significant
increase in body dissatisfaction from pre-advertisement exposure (M = 48.79, SD = 25.43) to
post-advertisement exposure (M = 53.15, SD = 24.83), t(67) = -2.03, p < .05. Thus, the
typically reported negative effect of thin-ideal media on body dissatisfaction was found in the
current sample.
Body Appreciation as a Predictor of Change in Body Dissatisfaction
Table 1 shows the zero-order correlations between body appreciation and other study
variables. As can be seen, body appreciation was significantly negatively related to body
dissatisfaction both initially, and following exposure to thin-ideal advertisements.
Table 1
Zero-order Correlations among Trait Body Image Measures, Proposed Mechanisms and
State Body Dissatisfaction (N = 68)
1 2 3 4 5
1. Body appreciation -
2. State self-objectification -.40* -
3. State social comparison -.34* .63** -
4. Pre-exposure body
dissatisfaction
-.50** .49** .34* -
5. Post-exposure body
dissatisfaction
-.65** .46** .44** .75** -
*p < .01. **p < .001.
87
To examine whether body appreciation predicted change in body dissatisfaction
following exposure to the thin ideal, a hierarchical multiple regression was conducted with
post-exposure body dissatisfaction as the outcome variable. Pre-exposure body dissatisfaction
was entered in Step 1 and proved significant, R2 = .564, F(1, 66) = 85.41, p < .001, β = .75.
More importantly, the addition of body appreciation at Step 2 significantly improved
prediction, R2
change = .097, Fchange(1, 65) = 18.52, p < .001, β = -.36. Thus, degree of body
appreciation predicted the degree of change in body dissatisfaction. The negative sign of the
regression coefficient (beta) for body appreciation (Step 2) indicates that with greater body
appreciation, there was less change in body dissatisfaction following exposure to
advertisements.
This finding is illustrated by dividing participants into tertiles based on their body
appreciation score: tertile one (n = 21, 1.46-2.92); tertile two (n = 24, 3.00-3.67); and tertile
three (n = 23, 3.69-5.00). Figure 1 shows pre- and post-exposure body dissatisfaction scores
for each of the three groups. It can be seen that participants with low and medium body
appreciation both experienced more body dissatisfaction initially, and reported an increase in
body dissatisfaction following exposure to the thin-ideal advertisements. In contrast,
participants with high body appreciation did not report any increase in body dissatisfaction in
response to exposure to the advertisements.
The Role of State Self-objectification and Appearance Comparison
Table 1 also displays correlations between body appreciation and the two
hypothesised explanatory mechanisms, state self-objectification and appearance comparison,
as well as their relationship to pre-and post-exposure body dissatisfaction. As can be seen,
body appreciation was negatively correlated with both state self-objectification and
appearance comparison. These two state measures were in turn positively correlated with
body dissatisfaction at both time points.
88
20
30
40
50
60
70
80
Pre Post
VA
S s
tate
bod
y d
issa
tisf
act
ion
sco
re
Body dissatisfaction
Low body appreciation
Medium body appreciation
High body appreciation
Figure 1. State body dissatisfaction change from pre- to post-exposure by body appreciation
tertiles.
Two separate hierarchical multiple regressions were conducted in order to test
whether state self-objectification and appearance comparison predicted change in body
dissatisfaction in their own right. In both regressions, pre-exposure body dissatisfaction was
controlled for in Step 1. In the first regression, state self-objectification was entered at Step 2,
and did not significantly add any additional variance, R2
change = .011, Fchange(1, 64) = 1.59, p
= .21, β = .12. However, when appearance comparison was entered at Step 2 in the second
regression, the model proved significant and indicated that appearance comparison predicted
change in body dissatisfaction, R2
change = .037, Fchange(1, 65) = 5.96, p = .02, β = .20. Here,
the positive sign of the beta indicates that more engagement in state appearance comparison
with the models in the advertisements predicted a greater increase in body dissatisfaction.
PROCESS macros (Hayes, 2013) were used to assess whether body appreciation
influenced state body dissatisfaction indirectly via state appearance comparison or state self-
89
objectification. Indirect effects were examined using bootstrapping of 5000 samples and
subsequent confidence intervals (CI), with mediation significant if the 95% bias-corrected CI
of the indirect path does not contain zero. Pre-exposure state body dissatisfaction was
controlled for in each mediation model. Results showed a significant direct effect of body
appreciation on state body dissatisfaction, b = -10.811, CI [-16.327, -5.295], but no
significant indirect effect from body appreciation to state body dissatisfaction via state
appearance comparison, b = -1.036, CI [-4.681, 0.176]. The same pattern of results was found
for state self-objectification, with a significant direct effect of body appreciation on state
body dissatisfaction, b = -11.755, CI [-17.465, -6.045], but no indirect effect through state
self-objectification, b = -.306, CI [-3.472, 0.912].
Exploration of Media Protective Strategies
The general (trait) media protective strategies that may help shield against potentially
harmful messages from media were explored. Correlations between general trait media
protective strategies and body appreciation are displayed in Table 2. It can be seen that all
media protective strategies (apart from the two negatively worded items, Items 8 and 10)
were positively related to body appreciation as would be expected. In particular, body
appreciation was significantly positively related to consciously thinking about digital
modifications in images (Item 2), reminding oneself of the variability in body shapes (Item
5), and not focusing on images that contain unattainable physiques (Item 7). Body
appreciation was also significantly positively related to the overall 7-item protective
processing subscale.
90
Table 2
Correlations between Trait Media Protective Strategies and Body Appreciation
Trait Media Protective Strategy Body Appreciation
Protective Processing
1. Attractive women in media images are not necessarily happy just
because they are attractive
.15
2. When I view ‘thin ideal’ media, I try to think about the digital
modifications that might have been made
.32**
3. Slender women in media images are not necessarily healthy just
because they are slender
.17
4. I think about how women in advertisements have had make-up artists,
hair dressers and stylists to enhance their appearance
.23a
5. I try to remind myself that all people are born with different body
shapes when I look at attractive and slender models
.46***
6. When I view images of models, I think that it is the model’s job to look
that way
.20
7. When I view media images that are physically not attainable for me, I
don’t focus on them
.50***
8. I do not question portrayals of women in media images, I automatically
accept them (reversed)
-.11
Total Protective Processing subscale b .36**
Media Avoidance
9. I intentionally avoid viewing television programs and movies that
contain ‘thin-ideal’ images
.02
10. I try to read as many fashion magazines as possible (reversed) -.12
11. I try not to pay attention to other people’s photos posted on social media
sites
.16
12. I pay attention to media images of women that do not make me feel bad
about myself
.15
Total Avoidance subscale c .11
Note. b
Contains Items 1 to 7, c Contains Items 9, 11 and 12;
a p < .07. *p < .05. **p < .01.
***p < .001.
91
Next, the strategies that participants reported they had actually used whilst viewing
the magazine advertisements (i.e., state media protective strategies) were explored in relation
to body appreciation and body dissatisfaction. Table 3 displays correlations between body
appreciation and each of the five state media protective strategies. As shown, body
appreciation was positively related with each of the five strategies, with significant
correlations for thinking about how models were not true representations of women in society
(Item 3) and how models look the way they do because it is their job (Item 4). A positive
correlation between the overall measure of state media protective strategies and body
appreciation was also found.
Table 3
Correlations between State Media Protective Strategies and Body Appreciation
State Media Protective Strategy
“Extent to which you thought about how…”
Body Appreciation
1. The advertisements might have been digitally altered to
improve appearance
.21a
2. The women in the advertisements may have had their
hair and make-up done by professionals
.20
3. The women in the advertisements were not a true
representation of women in society
.34**
4. The women in the advertisements look the way they do
because it is their job
.25*
5. The women in the advertisements might not necessarily
be healthy or happy
.10
Total scale .27*
a p < .10. *p < .05. **p < .01.
92
A hierarchical multiple regression analysis was then undertaken to determine whether
state media protective strategies could predict change in body dissatisfaction following media
exposure. Post-exposure body dissatisfaction was entered as the outcome variable. Pre-
exposure body dissatisfaction was entered at Step 1. At Step 2, the five state strategies were
entered together. Step 2 did not provide additional variance, R2
change = .038, Fchange(5, 61) =
1.18, p = .33, indicating that the state media protective strategies did not predict change in
body dissatisfaction.
Discussion
The current study aimed to extend knowledge regarding the ability of body
appreciation to protect women against harmful impacts of viewing thin-ideal media images.
The major finding was clear. Body appreciation predicted change in body dissatisfaction after
exposure to thin-ideal advertisements, such that higher body appreciation proved protective in
a way that lower levels of body appreciation did not. That is, women with lower body
appreciation reported increased body dissatisfaction following exposure to the thin ideal,
whereas women with high body appreciation reported no such change. In addition, state self-
objectification and state appearance comparison were examined as potential explanatory
mechanisms. While state appearance comparison was related to body appreciation and
predicted increased body dissatisfaction after viewing the advertisements, it did not account
for body appreciation’s protective effect. Finally, several trait and state media protective
strategies correlated positively with body appreciation, but use of state strategies did not
predict change in body dissatisfaction.
The current study has extended the findings reported by Halliwell (2013), using a
continuous measure of body appreciation and examining media-induced body dissatisfaction
as the outcome. In support of Halliwell (2013), body appreciation was found to be protective,
in that women with higher body appreciation reported less change in body dissatisfaction in
93
response to thin-ideal exposure. When faced with thin-ideal stimuli, women with higher body
appreciation dealt with this information in a body protective manner (Tylka, 2011), such that
their body satisfaction was not adversely affected at that time. Thus, the protective role
played by body appreciation has now been shown in two separate studies, with different
samples (United Kingdom, Australia), using different methodology and measures of body
image disturbance. Together, they present a convincing case that body appreciation in young
adult women serves a protective function against negative impacts from thin-ideal media
exposure. Future work could usefully examine this role in an adolescent sample, a group
particularly vulnerable to the development of body dissatisfaction (Striegel-Moore &
Cachelin, 1999). The ability of body appreciation to shield against potentially negative
consequences of exposure to other sources of negative body-related information, e.g.,
appearance-related comments (Tiggemann & Boundy, 2008), fat-talk (Stice, Maxfield, &
Wells, 2003), and exercising in objectifying environments (Prichard & Tiggemann, 2005),
should also be explored.
Although not the major aim of the study, implications regarding the potential for body
appreciation to protect against body dissatisfaction over the longer term may be drawn. In a
previous study, Hargreaves and Tiggemann (2003) found that those adolescent girls most
negatively affected by a single experimental exposure to thin-ideal images reported greater
body dissatisfaction and drive for thinness two years later. The authors reasoned that the
observed reaction to the experimental exposure was representative of daily encounters with
thin-ideal media, and that over time, individual experiences with such media would reinforce
and cumulate, resulting in increased body dissatisfaction (Hargreaves & Tiggemann, 2003).
In the present study, women who had little negative reaction to the thin-ideal images (women
with higher body appreciation) would likewise be expected to not experience increases in
body dissatisfaction in response to everyday thin-ideal stimuli, and so would not accumulate
94
body dissatisfaction. In line with this, participants who had higher body appreciation (and
reported less change in state body dissatisfaction) reported lower levels of initial body
dissatisfaction prior to the experimental exposure. Thus, body appreciation’s protective role
against negative effects from a single exposure to thin-ideal images may extend to cumulative
body dissatisfaction over time.
The present study also sought to examine potential mechanisms involved in body
appreciation’s protective effect on body satisfaction. Although, as predicted, body
appreciation was negatively correlated with state self-objectification, which was in turn
positively correlated with body dissatisfaction, state self-objectification did not predict
change in body dissatisfaction. However, appearance comparison with the model in the
advertisements did predict increased body dissatisfaction, supporting previous studies (e.g.,
Tiggemann & Polivy, 2010). Despite this, state appearance comparison did not account for
body appreciation’s protective effect. This indicates that body appreciation was protective for
reasons beyond decreasing comparison with the models in the advertisements. Future
research needs to explore exactly which mechanisms (if any) are responsible for body
appreciation’s influence on body dissatisfaction. For example, body appreciation and self-
compassion have been shown to be strongly correlated (Wasylkiw et al., 2012), and a self-
compassionate stance may help women to successfully reject negative messages from media
images.
Endorsement of media protective strategies was also explored in relation to body
appreciation. Results showed that body appreciation was positively related to general
awareness of widespread digital modifications, diversity of bodies, not focusing on images
with unattainable appearance, and to the overall (trait) protective processing scale. The media
avoidance scale was not significantly related to body appreciation. One explanation for this
finding is that women with higher body appreciation might acknowledge the difficulty in
95
avoiding thin-ideal media, so instead choose to actively engage in strategies to process
information. Further, it is probable that the relationship between body appreciation and media
protective strategies is reciprocal (Tylka, 2011, 2012), in that women with higher body
appreciation might be more inclined to use strategies to protect against media-related
appearance information, and use of such strategies likely strengthens body appreciation by
reinforcing acceptance of one’s own body. Future research should longitudinally investigate
the endorsement of (trait) media protective strategies in relation to the development of body
appreciation over some time to clarify this relationship.
The active use of (state) media protective strategies during thin-ideal exposure was
also examined. Body appreciation correlated positively with thinking about how models in
the viewed advertisements were not accurate representations of women in society, and
thinking about how it is the model’s job to look the way she does. However, state strategies
did not predict change in body dissatisfaction following thin-ideal exposure. In this, it is
important to note that participants retrospectively rated strategies that they may have
spontaneously used while undertaking the required tasks (i.e., focusing on the advertisement
and rating effectiveness and appeal). Providing explicit instructions to use strategies while
viewing the advertisements may have proved more successful in decreasing subsequent body
dissatisfaction. Thus, future investigations might consider experimental manipulations of
instructional set (requiring participants to engage in protective strategies) when exposed to
thin-ideal images.
The results of the present study point to several practical implications. Two targets
were identified as protective against media-induced body dissatisfaction. The first,
appearance comparison, has consistently been shown to be a predictor of body dissatisfaction
in the literature (for a meta-analysis, see Myers & Crowther, 2009). Here, however, body
appreciation emerged as a stronger target, in that it explained more variance in post-exposure
96
body dissatisfaction than did appearance comparison. Body appreciation (as a trait variable)
is also less susceptible to moment-to-moment influences. Thus, body appreciation appears to
be a worthwhile target for interventions that aim to reduce the impact of thin-ideal images on
body dissatisfaction. Furthermore, it has been suggested that attempting to increase body
appreciation may be an easier task than working to decrease levels of body dissatisfaction
(Andrew et al., 2014). Suggested strategies include encouraging participation in embodying
activities that emphasise the function, as opposed to the appearance, of one’s body, such as
athletics and yoga (Menzel & Levine, 2011; Tylka, 2012). Women might also be encouraged
to surround themselves with peers and social networks that focus on positive non-appearance
related qualities, and do not engage in body shaming and “fat-talk” (Tylka, 2012). These
strategies may assist in creating a healthy environment that fosters respect and appreciation
for one’s own body and simultaneously increases perceived acceptance of one’s body by
other people (Cook-Cottone, 2015), which has shown to predict body appreciation in young
women (Avalos & Tylka, 2006). Increasing body appreciation may also have other additional
benefits for women, including a more adaptive and intuitive eating style (Avalos & Tylka,
2006) and engaging in positive health care behaviour (Andrew et al., 2014).
There are some limitations of the present study that should be noted. First, the sample
consisted of mostly Caucasian, female undergraduate university students. Replication of the
present findings with a more diverse sample of women in terms of age, socio-economic status
and ethnicity is needed. Second, the current study was conducted under laboratory conditions.
In particular, participants were asked to pay attention to the magazine advertisements in a
different way from normal everyday reading of fashion magazines at home or in other natural
settings. On the other hand, our results showed that exposure to only 11 thin-ideal images (far
less than in a single issue of a fashion magazine) was sufficient to result in increased body
dissatisfaction. Third, the current study did not include a control group who were not exposed
97
to thin-ideal images. Inclusion of such a control condition would more conclusively
demonstrate that the effects on body dissatisfaction were attributable to the thin-ideal images,
rather than other aspects of the stimuli. Finally, although the majority of measures used were
well-established, the trait and state measures of media protective strategies needed to be
specifically constructed for this study. Hence, it is possible that important strategies that
women engage in may not have been included. The trait media avoidance subscale was also
found to have low internal reliability. Therefore, further psychometric investigation of the
created measures is required, along with exploration of other potentially important strategies,
such as focusing on body function and/or positive personality attributes.
Despite the limitations of the current study, the results have contributed to a clearer
understanding of body appreciation’s protective capacity against negative consequences of
media exposure. In short, the study has shown that body appreciation is able to some extent
shield young women against body dissatisfaction resulting from acute thin-ideal exposure.
Further work is needed to understand more fully the processes by which this occurs. Overall,
the findings have theoretical and practical implications, in particular in identifying positive
body image as an important target for minimising the negative impact of exposure to
idealised media images.
98
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http://dx.doi.org/10.1016/j.bodyim.2015.04.001
Wasylkiw, L., MacKinnon, A. L., & MacLellan, A. M. (2012). Exploring the link between
self-compassion and body image in university women. Body Image, 9, 236-245. doi:
10.1016/j.bodyim.2012.01.007
Webb, J. B., Wood-Barcalow, N. L., & Tylka, T. L. (2015). Assessing positive body image:
Contemporary approaches and future directions. Body Image, 14, 130-145. doi:
http://dx.doi.org/10.1016/j.bodyim.2015.03.010
Wood-Barcalow, N. L., Tylka, T. L., & Augustus-Horvath, C. L. (2010). “But I like my
body”: Positive body image characteristics and a holistic model for young-adult
women. Body Image, 7, 106-116. doi: 10.1016/j.bodyim.2010.01.001
World Health Organization. (2015). BMI classification. Retrieved 30 January 2015, from
http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
103
CHAPTER 5: Study 4 – Cross-sectional Analysis in Adolescent Girls
Predictors of Intuitive Eating in Adolescent Girls
Rachel Andrew, Marika Tiggemann, and Levina Clark
School of Psychology, Flinders University, South Australia
Corresponding author: Rachel Andrew, School of Psychology, Flinders University, GPO
Box 2100, Adelaide 5001, South Australia, Australia. Email:
Acknowledgements
The authors would like to thank the principals, teachers and in particular, the students who
participated in this study.
Statement of co-authorship:
All authors were involved in the formulation of the study concept and design. Rachel Andrew
collected the data, completed the data analysis and the initial draft of the manuscript. Marika
Tiggemann and Levina Clark edited multiple revisions of the manuscript.
This manuscript has been published as:
Andrew, R., Tiggemann, M., & Clark, L. (2015). Predictors of intuitive eating in adolescent girls.
Journal of Adolescent Health, 56, 209-214. doi: http://dx.doi.org/10.1016/j.jadohealth.2014.09.005
104
Abstract
Purpose: To examine proposed predictors of intuitive eating, including social appearance
comparison, and to test a modified acceptance model of intuitive eating in adolescent girls.
Methods: Participants were 400 adolescent girls aged 12-16 years who completed measures
of body acceptance by others, self-objectification, social appearance comparison, body
appreciation and intuitive eating. Results: Correlations showed that all proposed predictors
were related to intuitive eating in the expected direction. In particular, social appearance
comparison was negatively related to body appreciation and intuitive eating. After controlling
for other predictors, social appearance comparison was shown to explain unique variance in
intuitive eating. Using structural equation modeling, an integrated modified acceptance model
of intuitive eating yielded an overall good fit to the data. Mediation analyses showed that
there was a significant indirect effect of body acceptance by others on both body appreciation
and intuitive eating through social appearance comparison and self-objectification.
Conclusions: The findings extend the acceptance model of intuitive eating to adolescent girls,
but also identify social comparison as an important mechanism in this process. Practically,
the findings highlight several areas that may be targeted to foster adaptive eating patterns in
girls.
Key words: intuitive eating, adolescent girls, acceptance model, body appreciation,
social appearance comparison
Implications and contribution
This study found that predictors of intuitive (or adaptive) eating established for
women also apply to adolescent girls. In addition, girls’ social appearance comparison was
associated with lower levels of intuitive eating. These findings offer several targets for
interventions that attempt to increase adaptive eating in adolescent girls.
105
Research investigating eating behaviour has strongly focused on eating pathology and
has been less concerned with identifying predictors of adaptive eating (Tylka, 2006). A
similar trend is evident in the body image field with the bulk of previous research centred on
negative body image and body dissatisfaction (Tylka, 2011). Recently, however, there has
been an increase in examinations of adaptive eating and positive body image. In particular,
studies have examined intuitive eating (Tribole & Resch, 1995; Tylka, 2006) as a measure of
adaptive eating, and body appreciation as an index of positive body image (Avalos, Tylka, &
Wood-Barcalow, 2005).
Intuitive eating reflects a strong trust and connection with the internal hunger and
satiety cues that signal when and how much to eat (Tribole & Resch, 1995; Tylka, 2006). As
opposed to restrained eating, intuitive eating occurs in response to internal cues and not in
response to difficult emotions or distress. Those who eat intuitively are not preoccupied with
dieting and food, do not categorise food as “forbidden”, and food choices are a reflection of
preferred taste and a desire to assist the body’s functioning. In support of this
conceptualisation of intuitive eating, studies have shown that individuals who eat in response
to internal hunger and satiety cues engage in less overeating in the absence of hunger (Birch,
Fisher, & Davison, 2003), less eating in response to emotional or situational triggers (Woody,
Costanzo, Liefer, & Conger, 1981), and less food preoccupation (Faith, Scanlon, Birch,
Francis, & Sherry, 2004).
Correlational studies have reported significant associations between intuitive eating
and women’s health and psychological well-being. Intuitive eating has been shown to be
negatively related to disordered eating symptomatology, and positively associated with
optimism, life satisfaction, proactive coping, and self-esteem in young adult women (Tylka,
2006). Experimental studies of intuitive eating intervention programs have also reported
beneficial outcomes for psychological and physical well-being (Schaefer & Magnuson,
106
2014), for example, improved body satisfaction (Gagnon-Girouard et al., 2010), self-
acceptance, blood pressure (Bacon, Stern, Van Loan, & Keim, 2005) and increased physical
activity (Katzer et al., 2008). Importantly, intuitive eating is not associated with increased
Body Mass Index (BMI), but rather with no weight change (Katzer et al., 2008) or with
weight loss (Gagnon-Girouard et al., 2010).
Thus far, research on intuitive eating has mainly sampled adult women. Yet
examining intuitive eating in adolescent girls is imperative, because of the focus on
appearance, weight control and high rate of eating pathology (Paxton et al., 1991) during this
developmental period. Adolescence is also the time when attitudes and behaviours regarding
eating develop and can have negative impacts into young adulthood (Graber, Brooks-Gunn,
Paikoff, & Warren, 1994). To our knowledge, there are only two published studies examining
intuitive eating in adolescence. The first found that intuitive eating negatively related to
dieting pressure and negative emotions (e.g., sadness), and positively related to life and body
satisfaction and positive emotions (e.g., confidence, Dockendorff, Petrie, Greenleaf, &
Martin, 2012). In the second study, dieting for weight management was negatively related to
intuitive eating (Moy, Petrie, Dockendorff, Greenleaf, & Martin, 2013).
Drawing on Humanistic Theory (Rogers, 1961) and Objectification Theory
(Fredrickson & Roberts, 1997), Avalos and Tylka (2006) developed a model of intuitive
eating in adult women, termed “the acceptance model of intuitive eating”. This model was
first examined in college women (Avalos & Tylka, 2006), and subsequently in female college
athletes (Oh, Wiseman, Hendrickson, Phillips, & Hayden, 2012) and emerging, early-and
middle-aged adult women (Augustus-Horvath & Tylka, 2011). The model posits that body
acceptance by others assists women to resist self-objectification. Self-objectification occurs
when women internalise an observer’s perspective of themselves as an object to be evaluated,
and is characterised by habitual appearance monitoring (Fredrickson & Roberts, 1997).
107
Women who resist self-objectification are proposed to have higher levels of body
appreciation, which refers to the acceptance of, favourable opinions toward, and respect for
the body, irrespective of perceived flaws (Avalos et al., 2005). Body appreciation is
conceptualised as the proximal predictor of intuitive eating because women who appreciate
their bodies are more aware of bodily needs, and so respect their bodies by eating according
to internal cues (Avalos & Tylka, 2006).
In the acceptance model of intuitive eating, perceived body acceptance is postulated
to indirectly lead to body appreciation, via reduced self-objectification (Avalos & Tylka,
2006). People who perceive that others are accepting of their bodies are proposed to feel less
need to self-objectify by habitually monitoring their appearance (Avalos & Tylka, 2006).
Women who resist self-objectification should appreciate their own body to a greater extent,
regardless of perceived flaws. Self-objectification is also suggested to directly lead to
intuitive eating. Objectification Theory (Fredrickson & Roberts, 1997) posits that women
who do not focus on their external appearance have more resources available to attend to
internal bodily experiences (e.g., hunger and satiety cues), and so should eat more intuitively
(Avalos & Tylka, 2006).
It seems likely that the predictors contained within the acceptance model will also
predict intuitive eating in adolescent girls. It is particularly necessary to explore predictors
and mechanisms that influence intuitive eating in adolescence, while eating attitudes and
behaviours are still forming, as this may reveal appropriate intervention points to enhance
adaptive eating (Dockendorff et al., 2012). In addition to those predictors outlined in the
acceptance model of intuitive eating, one factor likely to be especially important for
adolescent girls is social appearance comparison.
Social Comparison Theory postulates that people compare their own qualities with
other people’s qualities to obtain information for self-evaluation (Festinger, 1954). In a recent
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meta-analysis, social comparison in the appearance domain was shown to be a strong
predictor of body dissatisfaction (Myers & Crowther, 2009), and has been reported to be
associated with body dissatisfaction in adolescent girls in particular (Jones, 2004; McLean,
Paxton, & Wertheim, 2013). Direction and target of comparison have been shown to impact
body image. Upward appearance comparison (e.g., to someone more physically attractive) is
related to lower appearance evaluation, whereas downward appearance comparison predicts
higher appearance evaluation (O’Brien et al., 2009), with adolescents’ target of comparison
more frequently peers than models (Jones, 2001). Girls’ social appearance comparison has
also been shown to relate to maladaptive eating indicators, such as extreme weight-loss
behaviour and binge eating (Schutz, Paxton, & Wertheim, 2002). Thus, social appearance
comparison was proposed as an additional mediator in the acceptance model. It was reasoned
that girls who receive body acceptance from family and friends will not only self-objectify
less, but will also have less need to evaluate and compare their appearance with others. In
sum, they are more likely to accept their bodies as they are, and experience higher body
appreciation and intuitive eating.
Taken together, the main aim of the present study was to examine whether the
predictors (body acceptance by others, self-objectification, and body appreciation) contained
within the acceptance model of intuitive eating (Avalos & Tylka, 2006) predict intuitive
eating in girls. In addition, social appearance comparison was examined as a potentially
useful addition to the acceptance model. The modified acceptance model, as outlined in
Figure 1, proposes that perceived body acceptance will be associated with reduced self-
objectification and reduced social appearance comparison. In turn, reduced self-
objectification and social appearance comparison are expected to be associated with both
increased body appreciation and intuitive eating.
109
+
-
+
-
-
-
-
-
Figure 1. Hypothesised modified acceptance model of intuitive eating for adolescent girls.
Methods
Design and Sample
This study utilised a cross-sectional design with participants assessed at one time
point. Participants were 400 adolescent girls between 12 and 16 years of age (M = 14.08, SD
= .90) who were in their first three years of secondary schooling: Year 8 (N = 178), Year 9 (N
= 155), Year 10 (N = 67). Participants were recruited from five (three private and two public)
secondary schools across metropolitan South Australia. The girls had a mean BMI of 20.90
(SD = 3.94), which is classified in the “normal weight” category (World Health Organization,
2015). Most girls self-identified as white/Caucasian (83.9%), with 10.3% Asian, 1.3%
African, 0.8% Aboriginal or Torres Strait Islander and 3.7% “other”.
Procedure
The protocol used in this study was approved by the relevant institutional research
board, the Catholic Education Office and the Department for Education and Child
Development Research Unit. Principals of schools were contacted to give permission for
Social
Appearance
Comparison
Body
Acceptance
by Others
Self-
objectification
Body
Appreciation
Intuitive
Eating
110
school participation. Parental consent was obtained through a Letter of Introduction,
Information Sheet and Consent Form. Girls also gave their own assent to participate.
Questionnaires were completed during normal class time in groups under the supervision of
teachers and the first author. As a token of appreciation, participants could enter into a raffle
to win one of five $20 vouchers for a clothing store.
Measures
Body acceptance by others. Perceived body acceptance by others was measured
using the Body Acceptance by Others Scale (Avalos & Tylka, 2006). Participants rate weight
and shape acceptance with regard to their friends, family, people whom they have dated,
society, and media, on a five-point scale from 1 (never) to 5 (always). For the present study,
this measure was abridged to assess only family and friend messages as these are of most
relevance for adolescent girls. The resulting scale had four items. An exemplar item is “I’ve
felt acceptance from my family regarding my shape and/or weight”. Items were averaged
with higher scores reflecting greater perceived body acceptance. The original scale has been
shown to have good internal consistency (α = .91), test-retest reliability (r = .85), and
construct validity in college women (Avalos & Tylka, 2006). For this sample, internal
consistency was acceptable (α = .75).
Self-objectification. Self-objectification was measured by the Body Surveillance
Subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996). The
subscale measures the extent to which participants monitor their bodies and view them in
terms of appearance as opposed to how they feel (McKinley & Hyde, 1996). The scale
consists of eight items (e.g., “I rarely think about how I look”), with responses rated from 1
(strongly agree) to 7 (strongly disagree), with a “not applicable” option coded as missing.
Scores are averaged with higher scores indicating higher levels of self-objectification. This
measure has been shown to be reliable and valid in adults (McKinley & Hyde, 1996), and
111
internally consistent in adolescent girls (α = .86, Slater & Tiggemann, 2002). In the present
sample the reliability was acceptable (α = .80).
Social appearance comparison. Social appearance comparison was assessed using
the five-item Physical Appearance Comparison Scale (Thompson, Heinberg, & Tantleff-
Dunn, 1991). Participants rate on a scale from 1 (never) to 5 (always) their tendency to
compare their overall appearance with other people’s appearance. An exemplar item is “In
social situations, I sometimes compare my figure to the figures of other people”. This scale
has been shown to have high test-retest reliability (α = .78) in adolescent girls (Schutz et al.,
2002), and correlated highly with upward and downward appearance comparison in college
students (O’Brien et al., 2009). The internal reliability in the present sample of adolescents
fell just short of acceptable (α = .67). Examination of the item-scale correlations indicated
that this was due to the one negatively-worded item (item 4), as has been found previously
with adolescents (Tiggemann & Miller, 2010). Therefore, item 4 was removed, and the
remaining four items were summed with scores ranging from 4 to 20. The resulting internal
reliability was acceptable (α = .79).
Body appreciation. Body appreciation was measured with the Body Appreciation
Scale of Avalos et al. (2005) which measures appreciation, acceptance, respect, and
protection of one’s body. Participants rate 13 items (e.g., “Despite my flaws, I accept my
body for what it is”) on a five-point Likert scale from 1 (never) to 5 (always). Items are
averaged with higher scores reflecting more body appreciation. This scale has been shown to
demonstrate good test-retest reliability (r = .90), construct and discriminant validity (Avalos
et al., 2005), and is internally consistent (α = .88) with adolescents (Lunde, 2013). For the
present sample, internal reliability was high (α = .93).
Intuitive eating. Intuitive eating was measured with the Intuitive Eating Scale for
Adolescents (Dockendorff et al., 2012). This was designed to address unconditional
112
permission to eat, eating for physical rather than emotional reasons, awareness of internal
satiety and hunger cues, and trust in these cues. Participants rate 17 items (e.g., “I try to avoid
certain foods high in fat, carbohydrates, or calories”) on a Likert-scale from 1 (strongly
disagree) to 5 (strongly agree). The scale has demonstrated validity, and although no overall
reliability coefficient is provided (Dockendorff et al., 2012), in the current sample overall
internal consistency was acceptable (α = .83).
Results
Correlational Analysis
Table 1 displays the means and inter-correlations for all variables. As can be seen, all
variables were significantly related to each other (at p < .001). Importantly, all proposed
predictors correlated with intuitive eating. Specifically, body acceptance by others
(positively), self-objectification (negatively), social appearance comparison (negatively), and
body appreciation (positively) were significantly related to intuitive eating.
Table 1
Means (and Standard Deviations [SD]) and Correlations Among Study Measures (N = 400)
M (SD)
Response
range 1 2 3 4 5
1. Body acceptance
by others
4.04 (.82) 1 - 5 -
2. Self-
objectification
4.54 (1.11) 1 - 7 -.21* -
3. Social appearance
Comparison
12.17 (3.39) 4 - 20 -.27* .56* -
4. Body
appreciation
3.39 (.81) 1 - 5 .45* -.52* -.51* -
5. Intuitive eating 3.22 (.57) 1 - 5 .31* -.42* -.47* .53* -
* p < .001.
113
Predictors of Intuitive Eating in Adolescent Girls
The variables contained within the acceptance model were examined for their ability
to predict intuitive eating in girls. A hierarchical multiple regression was performed with
body acceptance by others, self-objectification and body appreciation entered in Step 1, and
intuitive eating entered as the outcome variable. This showed that the predictors together
explained a significant 31.5% of variance in intuitive eating, R2
= .315, F(3,391) = 59.98, p <
.001.
To determine whether social appearance comparison explained additional variance in
intuitive eating, over and above those variables contained in the original acceptance model,
social appearance comparison was entered in Step 2 of the hierarchical multiple regression.
Social comparison explained a significant additional 2.8% of variance in intuitive eating,
R2
Change = .028, FChange(1,390) = 16.54, p < .001, after controlling for predictors from the
acceptance model. As can be seen from the regression coefficients in Table 2, self-
objectification, social appearance comparison, and body appreciation offered independent
unique prediction of intuitive eating, with social appearance comparison the second strongest
predictor of intuitive eating (after body appreciation).
Test of the Proposed Acceptance Model of Intuitive Eating
The modified acceptance model of intuitive eating in adolescent girls was examined
using structural equation modeling. The maximum likelihood method of structural equation
modeling was used (AMOS version 20). All variables were treated as observed variables.
Less than 1% of cases were missing for any one variable, with mean substitution used to
replace missing data. As recommended by Hu and Bentler (1999), the comparative fit index
(CFI), the Tucker-Lewis index (TLI), the standardised root-mean square residual (SRMR),
and the root-mean square error of approximation (RMSEA), were used to evaluate adequacy
of model fit. Hu and Bentler (1999) suggest that values of .95 or higher for CFI and TLI, and
114
.08 and .06 or lower for SRMR and RMSEA respectively, indicate a relatively good fit.
Values of .90 - .94 for CFI and TLI, .09 - .10 for SRMR and .07 - .10 for RMSEA indicate
acceptable fit.
Table 2
Summary of Hierarchical Multiple Regression of Variance Explained in Intuitive Eating (N =
395)
The fit indices for the proposed model suggested a less than acceptable fit: χ² =
134.99, df = 2, p < .001, CFI = .77, TLI = -.18, SRMR = .15, RMSEA = .41. Examination of
the modification indices indicated an additional pathway from self-objectification to social
appearance comparison. The model was re-estimated with the inclusion of this pathway, and
demonstrated an overall acceptable to good fit to the data: χ² = 2.97, df = 1, p = .09, TLI =
.97 (good), CFI = .99 (good), SRMR = .02 (good), RMSEA = .07 (acceptable). Figure 2
B SE B β
Step 1
Constant 2.51 .22
Body acceptance by others .06 .03 .09
Self-objectification -.10 .03 -.20**
Body appreciation .27 .04 .39**
Step 2
Constant 2.92 .24
Body acceptance by others .05 .03 .08
Self-objectification -.06 .03 -.11*
Body appreciation .23 .04 .33**
Social appearance comparison -.04 .01 -.21**
Note. R2 = .315 for Step 1. ΔR
2 = .028 for Step 2, (p < .001); SE = standard error of
the unstandardised coefficient; * p < .05. ** p < .001.
115
-.21**
-.16**
.52**
.32**
-.32**
-.25**
.36**
-.22**
-.11*
presents the standardised path coefficients for the final model. Perceived body acceptance
was negatively associated with self-objectification and social appearance comparison, and
positively related to body appreciation. Self-objectification and social appearance comparison
were negatively associated with both body appreciation and intuitive eating. Finally, body
appreciation was positively related to intuitive eating.
Figure 2. Structural parameters for the final model of the acceptance model of intuitive eating
in adolescent girls. Standardised regression coefficients shown. Fit indexes: χ² = 2.97, df = 1,
p = .09, Tucker-Lewis index = .97 (good), comparative fit index = .99 (good), standardised
root-mean-square residual = .02 (good), root-mean-square error of approximation = .07
(acceptable).* p < .05. **p < .001.
Mediation was formally tested using a bootstrapped multiple mediation model as
described by Hayes (2013). Bootstrapping of 5000 samples was used to examine indirect
effects and related confidence intervals (CI), with mediation significant if the 95% bias-
Body
Acceptance
by Others
Self-
objectification
Social
Appearance
Comparison
Body
Appreciation
Intuitive
Eating
116
corrected CI of the indirect path does not contain zero. Results showed significant indirect
effects from body acceptance by others to body appreciation via both social appearance
comparison, b =.067, CI [.035 - .112], and self-objectification, b =.065, CI [.030 - .111]. This
was also the case for the significant indirect effects of body acceptance by others on intuitive
eating, via social appearance comparison, b =.054, CI [.029 - .088] and self-objectification, b
=.031, CI [.013 - .059].
Discussion
The present study sought to extend knowledge regarding the predictors of intuitive
eating in adolescent girls. The major findings are clear. First, the variables outlined in the
acceptance model of intuitive eating, namely body acceptance by others, self-objectification
and body appreciation, showed significant associations with intuitive eating in our sample of
girls. Second, social appearance comparison was significantly related to both body
appreciation and intuitive eating. Finally, the modified acceptance model of intuitive eating
was supported in this age group.
The primary aim of the present study was to extend examination of the predictors of
intuitive eating, as outlined in the acceptance model of intuitive eating (Avalos & Tylka,
2006), to adolescent girls. As previously shown in adult women (Augustus-Horvath & Tylka,
2011; Avalos & Tylka, 2006; Oh et al., 2012), we found that perceived friend and family
body acceptance influences levels of self-objectification, which is in turn associated with
body appreciation and intuitive eating. Our results have extended the two previous studies of
intuitive eating in adolescents (Dockendorff et al., 2012; Moy et al., 2013). Together, the
studies confirm that intuitive eating is an important and relevant concept for adolescent girls.
Indeed, intuitive eating may be particularly important for girls during adolescence when
attitudes toward eating are developing (Graber et al., 1994), and when girls may be
vulnerable to disordered eating (Paxton et al., 1991). Chronic eating problems during
117
adolescence have been shown to be related to depressed mood and maladaptive eating in
young adulthood (Graber et al., 1994). On the other hand, intuitive eating has been shown to
have positive benefits for physical and psychological health (Schaefer & Magnuson, 2014).
Longitudinal research should address whether intuitive eating during adolescence helps
promote adaptive eating and other healthy outcomes into young adulthood.
The present study also demonstrated that social appearance comparison is an
additional significant mediator between body acceptance by others and both body
appreciation and intuitive eating. Female adolescents have been shown to engage in social
appearance comparison more than their male counterparts (Jones, 2001), and engaging in
social appearance comparison may be a particularly relevant and informative process for
girls. Meeting perceived appearance expectations is one strategy used to earn acceptance
within adolescent peer groups, and social comparison can be utilised to measure one’s own
appearance against standards (Jones, 2001). If comparisons are unfavourable, continued
comparison will reinforce the discrepancy between current and ideal appearance (Tylka &
Sabik, 2010), and negatively impact body image. In support, one longitudinal investigation
showed that girls’ initial levels of social appearance comparison predicted increased body
dissatisfaction one year later (Jones, 2004). Our own results showed that reduced engagement
in social appearance comparison was associated with higher levels of both body appreciation
and increased intuitive eating.
Body appreciation was shown to be the strongest predictor of intuitive eating in the
present sample. Encouraging body appreciation in adolescent girls may be particularly useful
because of the physiological and appearance changes that occur during puberty, which can be
a source of body-related concern, especially for those girls who mature earlier, or later,
compared to peers (Wertheim & Paxton, 2011). Girls with higher levels of body appreciation
may be able to better appreciate and accept these changes as normal and functional for the
118
body (i.e., leading to a more embodied experience, Piran & Teall, 2013), and thus may not
feel the need to ignore internal eating signals in order to modify appearance.
The results suggest three targets to increase body appreciation in adolescent girls:
body acceptance by others, self-objectification and social appearance comparison. While it is
difficult to change the first of these (the views of others), the latter two processes may more
readily modifiable. In particular, school run media literacy programs could incorporate
information about the media’s presentation of body ideals and image manipulation to
decrease social comparison (Myers & Crowther, 2009). Social appearance comparison has
previously been successfully decreased through targeted experimental interventions that
highlight the unrealistic and artificial nature of images or genetic predisposition to weight
(Posavac, Posavac, & Weigel, 2001). Girls could also be assisted with strategies to resist and
respond to sexual-and self-objectification (Tylka & Augustus-Horvath, 2011). Participation
in activities that emphasise the body’s functionality and physical competence rather than
appearance (e.g., basketball or yoga) have been suggested as one way to resist self-
objectification (Tylka & Augustus-Horvath, 2011).
As with all research, the limitations of the present study should be acknowledged.
Although the sample of participants was relatively large and was drawn from schools from
varying geographical locations in metropolitan South Australia, the sample was limited to
Australian girls aged 12 to 16 years who were predominantly white. Thus, the results cannot
necessarily be generalised to adolescents from other cultures and ethnicities. In particular, the
modified model needs to be confirmed in further samples of girls and extended to adolescent
boys and adult women. In addition, our ability to draw firm causal conclusions is limited by
the cross-sectional design. Structural equation modeling techniques assess the strength of
relationships, which are based on prior findings or theory (in this case, the acceptance model
of intuitive eating), but do not of themselves indicate causation or directionality. Therefore,
119
the tested model provides one possible combination of the relationships tested. Although less
plausible, it is possible, for example, that girls who eat intuitively engage in less social
appearance comparison. Only studies that employ longitudinal designs that track factors over
time can offer more definitive causal conclusions.
Despite these limitations, the present study has contributed to the understanding of
intuitive eating in contemporary adolescent girls. As the first examination of the acceptance
model in this age group, it has not only extended knowledge regarding predictors of intuitive
eating in adolescent girls, but also has theoretical implications for the acceptance model as a
framework for understanding intuitive eating. Social appearance comparison was shown to be
an additional predictor. In sum, we have provided an extended acceptance model of intuitive
eating in adolescent girls, one which offers a more complete description and highlights
potential targets for intervention in this population.
120
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CHAPTER 6: Study 5 – Longitudinal Follow-up of Adolescent Girls
Predictors and Health-Related Outcomes of Positive Body Image in Adolescent Girls: A
Prospective Study
Rachel Andrew, Marika Tiggemann, and Levina Clark
School of Psychology, Flinders University, South Australia
Statement of co-authorship:
All authors were involved in the formulation of the study concept and design. Rachel Andrew
collected the data, completed the data analysis and the initial draft of the manuscript. Marika
Tiggemann and Levina Clark edited multiple revisions of the manuscript.
Copyright © 2016 American Psychological Association. Reproduced with permission. The
official citation that should be used in referencing this material is Andrew, R., Tiggemann,
M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in
adolescent girls: A prospective study. Developmental Psychology, 52(3), 463-474.
http://dx.doi.org/10.1037/dev0000095. This article may not exactly replicate the authoritative
document published in the APA journal. It is not the copy of record. No further reproduction
or distribution is permitted without written permission from the American Psychological
Association.
Link to authoritative document (DOI): http://dx.doi.org/10.1037/dev0000095
126
Abstract
This study aimed to investigate prospective predictors and health-related outcomes of
positive body image in adolescent girls. In so doing, the modified acceptance model of
intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years
completed a questionnaire containing measures of body appreciation, potential predictors,
and a range of health outcomes, at two time points separated by one year. Longitudinal
change regression models showed that perceived body acceptance by others (positively), self-
objectification and social comparison (negatively) and body appreciation (positively)
prospectively predicted intuitive eating one year later, consistent with the acceptance model
of intuitive eating. Perceived body acceptance by others was the only proposed predictor to
prospectively predict an increase in body appreciation over time. Time 1 body appreciation
prospectively predicted a decrease in dieting, alcohol and cigarette use, and an increase in
physical activity one year later. In particular, girls with low body appreciation were more
likely than girls with high body appreciation to take up alcohol and cigarette use between
time points. The results highlight body appreciation as an important target for interventions
designed to prevent or delay the uptake of alcohol and cigarette consumption among girls.
More broadly, they suggest that a positive body image can confer considerable benefit for
adolescent girls.
Key words: adolescent girls, positive body image, body appreciation, prospective
study, intuitive eating, health behaviours
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Body image is recognised as a complex and multi-faceted construct that affects
cognitive, behavioural and emotional functioning (Pruzinsky & Cash, 2002). Despite this
broad conceptualisation of body image, the majority of body image research has focused on
understanding and investigating negative aspects of body image (Tylka, 2011). Recently,
however, there has been an increase in examinations of positive and adaptive components of
body image. Positive body image is broadly described as the love, respect and acceptance of
one’s appearance and physical function (Wood-Barcalow, Tylka, & Augustus-Horvath,
2010), and is distinct from body satisfaction or a lack of negative body image (Tylka, 2011;
Tylka & Wood-Barcalow, 2015a; Wood-Barcalow et al., 2010). Qualitative studies have
revealed common characteristics of people with positive body image, including body
acceptance, taking a functional view of the body, filtering appearance information in a
protective manner, and advocating a broad conceptualisation of beauty (Bailey, Gammage,
van Ingen, & Ditor, 2015; Frisén & Holmqvist, 2010; Holmqvist & Frisén, 2012; McHugh,
Coppola, & Sabiston, 2014; Wood-Barcalow et al., 2010).
Positive body image is most commonly measured by the Body Appreciation Scale
(Avalos, Tylka, & Wood-Barcalow, 2005). This scale assesses acceptance, respect and
attention toward bodily needs, favourable opinions towards one’s body and rejection of
media messages depicting narrow beauty ideals (Avalos et al., 2005). Body appreciation has
been shown to relate to adaptive psycho-social indicators of well-being including self-esteem,
optimism (e.g., Avalos et al., 2005), and self-compassion (Albertson, Neff, & Dill-
Shackleford, 2014; Wasylkiw, MacKinnon, & MacLellan, 2012). In experimental studies,
body appreciation has been shown to protect against media-induced body image disturbance
(Andrew, Tiggemann, & Clark, 2015a; Halliwell, 2013). To date, the majority of research
examining body appreciation has used samples of adult women. Given that a considerable
proportion of adolescent girls report marked body dissatisfaction (Thompson, Heinberg,
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Altabe, & Tantleff-Dunn, 1999), it is important that development of positive body image be
investigated before adulthood.
Adolescence is a time associated with significant social, physical and emotional
change (Eccles, 1999). For girls, puberty brings about physical transitions in body
composition, including increased fat deposits on areas such as the hips (Wertheim & Paxton,
2011), that move appearance further away from cultural definitions of beauty (e.g., thinness).
Although the study of negative body image in adolescent girls is extensive, as yet only a
small number of studies have investigated positive body image in adolescents. In a sample of
Spanish adolescent girls, body appreciation correlated positively with self-esteem and
adaptive coping, and negatively with eating disorder symptomology (Lobera & Ríos, 2011;
Lobera, Ríos, Fernández, & Casals Elsa Sánchez, 2011). In Australian adolescent girls,
positive relationships were found with perceived body acceptance by others and intuitive
eating (Andrew, Tiggemann, & Clark, 2015b). The current study aims to expand upon these
limited findings by investigating a range of potential predictors and outcomes of body
appreciation in adolescent girls.
The Acceptance Model of Intuitive Eating
Halliwell (2015) recently emphasised the importance of testing theoretical models in
advancing the study of positive body image. The acceptance model of intuitive eating
(Avalos & Tylka, 2006) considers body appreciation to proximally predict an adaptive style
of eating called intuitive eating. Intuitive eating involves attending to internal hunger and
satiety cues to inform eating behaviour, as opposed to eating in response to external cues or
restricting intake (Tribole & Resch, 1995; Tylka, 2006). This model proposes that perceived
body acceptance by others indirectly predicts body appreciation and intuitive eating through
decreased self-objectification (the adoption of an observer's perspective of the body,
Fredrickson & Roberts, 1997). People who feel others accept their body should feel less need
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to monitor their outward appearance (Avalos & Tylka, 2006). Reduced self-objectification is
proposed to predict increased body appreciation and intuitive eating, as those who pay
attention to body function should appreciate their body for its abilities, instead of focusing on
perceived flaws, and should have more resources to attend to physical hunger cues (Avalos &
Tylka, 2006; Fredrickson & Roberts, 1997). Body appreciation directly predicts intuitive
eating because people with higher body appreciation should have a heightened awareness of
bodily needs and act with respect towards their body (Avalos & Tylka, 2006).
The acceptance model of intuitive eating has been tested and confirmed cross-
sectionally in undergraduate women (Avalos & Tylka, 2006), college athletes (Oh, Wiseman,
Hendrickson, Phillips, & Hayden, 2012) and in young and middle-aged adult women
(Augustus-Horvath & Tylka, 2011). More recently the model was shown to hold in a sample
of Australian adolescent girls (Andrew et al., 2015b). These authors also reported that
reduced social appearance comparison was an additional (negative) mediator in the positive
relationships between perceived body acceptance by others and both body appreciation and
intuitive eating. Thus, their modified acceptance model of intuitive eating included both self-
objectification and social appearance comparison as mediators (Andrew et al., 2015b).
The current study sought to longitudinally examine the modified acceptance model of
intuitive eating in adolescent girls, a group undergoing a period of development associated
with eating attitude formation (Graber, Brooks-Gunn, Paikoff, & Warren, 1994) and
heightened risk of disordered eating (Paxton et al., 1991). All previous tests of the acceptance
model of intuitive eating have been limited to correlational designs. Correlational studies
cannot confidently determine the direction of causality between variables. For example, while
the acceptance model postulates that body appreciation leads to intuitive eating, the converse
causal direction is also plausible. That is, engaging in an adaptive and intuitive eating style
might lead to greater body appreciation. A minimum requirement for causality is temporal
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precedence (Menard, 1991). This can be tested using longitudinal methodology by examining
whether a proposed cause (e.g., body appreciation) is temporally antecedent to (occurs
before) the proposed effect (e.g., intuitive eating). Thus the use of a longitudinal research
design allows for a more rigorous test of proposed causal relationships within a model.
Predictors of Body Appreciation
Beyond tests of the acceptance model of intuitive eating, other predictors of positive
body image have not yet been explored in any age group. Understanding factors associated
with body appreciation is critical in identifying potential practical targets to enhance body
appreciation (Tylka, 2011). This may be particularly important for adolescents who are still
in the process of developing and managing self-esteem, individuality and sense of identity
(Eccles, 1999). The current study explored three potential classes of predictors. The first was
perceived body acceptance by others (as postulated in the acceptance model of intuitive
eating). This has been shown cross-sectionally to relate to body appreciation in both women
(e.g., Avalos & Tylka, 2006) and adolescent girls (Andrew et al., 2015b), but has not yet been
investigated longitudinally. The second type of predictor was consumption of various forms
of media, and the third was engagement in different types of activities. Both of these aimed to
assess the impact of girls’ engagement in everyday behaviours on body appreciation.
In general, girls’ media consumption has been shown to have negative effects on body
image. For example, a recent meta-analysis concluded that there was a relationship between
exposure to mass media emphasising the thin-ideal and vulnerability to body image
disturbances (Grabe, Ward, & Hyde, 2008). Thus, we propose that adolescent girls who
consume less appearance-based media will show greater body appreciation, as a result of
decreased levels of exposure to messages emphasising the importance of appearance.
Likewise, greater exposure to non-appearance media that highlight ability (e.g., cooking
shows) or that engage girls intellectually (e.g., documentaries) may enhance body
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appreciation. In addition, Menzel and Levine (2011) have proposed that engaging in
embodying activities, i.e., activities which involve a mind-body integration (Piran, 2001,
2002), is key to positive body image. Accordingly, we propose that playing sports or other
physical activities that place emphasis on body function (e.g., soccer) should enhance body
appreciation. We also expected that participating in hobbies and other engaging activities,
such as playing a musical instrument, may also foster body appreciation because, as
suggested by Halliwell (2015), such activities emphasise one’s physical capabilities and the
mind-body connection.
Outcomes of Body Appreciation
One facet of positive body image is investment in the care of the body and its physical
needs (Tylka, 2011, 2012), and thus Tylka and Wood-Barcalow (2015a) have suggested that
positive body image may be protective of physical health. To our knowledge, there have been
only two studies, both correlational, investigating the health-related outcomes of body
appreciation outside of intuitive eating. In the first, Andrew, Tiggemann and Clark (2014)
found that body appreciation was positively associated with sun protection, skin screening
and seeking medical attention when needed, and negatively related to weight-loss behaviour
in adult women. In the second, Gillen (2015) reported that body appreciation was positively
correlated with intentions to protect skin from sun damage and negatively related with dieting
in young adult men and women.
As yet, potential health outcomes of positive body image (other than intuitive eating)
have not been examined in adolescents; nor has there been any longitudinal study of health
outcomes in any age group. The adolescent period is associated with the development of
personal autonomy (Eccles, 1999), including increased choices around behaviours that impact
on health. In addition, healthy habits developed during this period can have benefits into
adulthood (Aarts, Paulussen, & Schaalma, 1997). In the current study, we examined a range
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of health behaviour outcomes, both adaptive and harmful. The adaptive health behaviours
included consumption of the recommended intake of fruit and vegetables, sun protection,
adequate sleep and seeking medical attention. Potentially harmful behaviours examined were
dieting, consumption of takeaway food, and alcohol and cigarette use.
The Current Study
In sum, the current study sought to extend the understanding of both predictors and
health outcomes of body appreciation in adolescent girls, using a longitudinal research
design. The study had three specific aims. The first aim was to longitudinally test the
modified acceptance model of intuitive eating (Andrew et al., 2015b; Avalos & Tylka, 2006)
in adolescent girls. The second aim was to explore prospective predictors of body
appreciation in adolescent girls, in particular, perceived body acceptance by others,
consumption of appearance and non-appearance-based media, and engagement in sports and
hobbies. The third aim was to longitudinally examine a range of health-related outcomes of
body appreciation, namely, dieting, fruit, vegetable and takeaway consumption, sun
protection, sleep, medical attention and alcohol and cigarette use.
Method
Participants
Participants were 298 girls recruited from five schools (two co-educational public
schools and three private single-sex schools) in metropolitan South Australia. The girls were
a subset of a larger cross-sectional study (Time 1, N = 400) investigating a model of intuitive
eating in girls (Andrew et al., 2015b). The retention rate was 74.5% at Time 2. The girls were
in Years 8, 9 or 10 at Time 1 and had a mean age of 14.03 years (SD = 0.88). At Time 2, one
year later, the girls were in Years 9, 10 or 11 and had a mean age of 15.02 years (SD = 0.85).
Attrition was mostly due to absenteeism or girls having left the school. Attrition analyses
showed that there were no significant differences between girls who did and did not complete
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the Time 2 follow-up on any Time 1 study variable. The sample was predominantly
Caucasian (> 85%). The schools ranged in socio-economic status, with Socio-Economic
Indexes for Areas (SEIFA; Australian Bureau of Statistics, 2011) based on school postcodes
ranging from decile 2 (low) to decile 8 (high).
Measures
Participants completed a questionnaire at Time 1 and then again approximately one
year later (Time 2). The questionnaire contained measures of activities and media
consumption, followed by the key measures of body appreciation, self-objectification, social
appearance comparison and perceived body acceptance (in that order), followed by health
behaviours including intuitive eating, and general demographic information.
Body appreciation. Body appreciation was measured by the Body Appreciation
Scale (BAS) of Avalos and colleagues (2005). Participants rate 13 items (e.g., “Despite my
flaws, I accept my body for what it is”) on a 5-point scale ranging from never (1) to always
(5). Items are averaged with higher scores reflecting higher levels of body appreciation. The
BAS has demonstrated 3-week test-retest reliability (r =.90), construct and discriminant
validity (Avalos et al., 2005), and has been shown to have high internal reliability (α = .88) in
an adolescent sample (Lunde, 2013). For the present sample, internal reliability was high at
both Time 1 (α = .93) and Time 2 (α = .94).
Media consumption. A set of 11 items assessing media consumption was constructed
for the study. The first three questions assessed magazine consumption. Participants were
asked to rate how often they read “Teen (e.g., Dolly)”, “Fashion (e.g., Vogue)”, and “Other
magazines (e.g., Rolling Stone, Better Homes and Gardens)”, on a scale ranging from never
(1) to every time an issue comes out (5). The remaining eight items were rated from never (1)
to all the time (5). The first two questions asked participants to rate how often they view
“Fashion websites/blogs/online material”, and how often they use “Social media (e.g.,
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Facebook)”. Finally, television viewing was assessed with six items asking participants to
rate how often they watch “Soapies or dramas”, “Music television shows”, “Talent-based
reality television (e.g., Top Model)”, “Non-talent based reality television (e.g., Big Brother)”,
“Cooking (e.g., Master Chef ) or construction (e.g., The Block) shows”, and “Information
based shows (e.g., documentaries or the news)”. From these items, measures of appearance
and non-appearance media consumption were created. The measure of appearance media
summed items assessing consumption of teen magazines, fashion magazines, fashion
websites, social media, and watching soapies, music television, and talent and non-talent-
based reality television. Internal reliability was acceptable (Time 1, α = .70, Time 2, α = .73).
The three items measuring non-appearance media (reading other magazines, watching
cooking or construction television shows and watching information based television) did not
cohere together at Time 1 (α = .48) or Time 2 (α = .47), and thus were examined separately.
Activities. Two types of activities were assessed with a measure constructed for the
study. Nine items addressed sports and physical activities. These were walking, yoga/pilates,
swimming, running, bike riding, hiking, martial arts, dance and organised sports (e.g.,
soccer). Seven items addressed hobbies or other engaging activities: reading, playing a
musical instrument, attending church, volunteering, belonging to a group/organisation, doing
drama and arts/crafts. Participants indicated whether or not they engaged in each activity,
how many sessions per week they engaged in that activity (frequency), and for how many
minutes per session (duration). Time spent on each activity was calculated by multiplying
each activity’s frequency by its duration. Time spent engaged in physical activities was
calculated by summing minutes spent on each of the nine sporting and physical activities.
Time spent on hobbies was calculated by summing minutes spent on the seven hobbies listed.
Body acceptance by others. Perceived body acceptance by others was measured
using the Body Acceptance by Others Scale (Avalos & Tylka, 2006). Participants rate items
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relating to perception of how accepting important others are of their weight and shape on a 5-
point scale ranging from never (1) to always (5). The original 10-item scale assessed body
acceptance by family, friends, dating partners, society and the media. In the current study,
these questions were asked in relation to family and friends. The resulting scale had four
items (e.g., “I’ve felt acceptance from my family regarding my shape and/or weight”). Items
were averaged with higher scores indicative of greater perceived body acceptance by others.
The original measure has been shown to have good internal consistency (α =.91), 3-week
test-retest reliability (r =.85), and construct validity in college women (Avalos & Tylka,
2006). In the present sample, internal reliability was acceptable at Time 1 (α =.74) and Time
2 (α = .79).
Self-objectification. Self-objectification was measured by the Body Surveillance
Subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996). The
subscale examines monitoring of one’s body and perceiving it in terms of appearance as
opposed to function (McKinley & Hyde, 1996). The scale consists of eight items (e.g., “I
rarely think about how I look”). Participants rate each item on a scale ranging from strongly
agree (1) to strongly disagree (7), with a not applicable option coded as missing. Scores are
averaged and higher scores reflect higher self-objectification. This measure has been shown
to be reliable and valid in adults (McKinley & Hyde, 1996), and internally consistent in a
sample of Australian adolescent girls (α =.86, Slater & Tiggemann, 2002). In the current
study, internal reliability was acceptable at Time 1 (α =.79) and Time 2 (α =.84).
Social comparison. Social appearance comparison was assessed using the Physical
Appearance Comparison Scale (Thompson, Heinberg, & Tantleff-Dunn, 1991). Participants
rate five items (e.g., “In social situations, I sometimes compare my figure to the figures of
other people”) on a 5-point scale from never (1) to always (5). This scale has demonstrated
high 3-week test-retest reliability (r =.78) in adolescent girls (Schutz, Paxton, & Wertheim,
136
2002), and was highly correlated with upward and downward appearance comparison in
college students (O’Brien et al., 2009). At Time 1, the internal reliability fell short of
acceptable (α =.66). Item-scale correlations indicated that low internal reliability was due to
the one negatively-worded item (item 4), which has been previously reported in adolescent
samples (Tiggemann & Miller, 2010). Therefore, item 4 was removed from Time 1 and Time
2 scales, and the remaining four items were summed with scores ranging from 4 to 20. The
resulting internal reliability was acceptable at Time 1 (α =.80) and Time 2 (α =.81).
Intuitive eating. Intuitive eating was measured with the Intuitive Eating Scale for
Adolescents (Dockendorff, Petrie, Greenleaf, & Martin, 2012). This scale aims to assess
unconditional permission to eat, eating for physical rather than emotional reasons, and
awareness and trust in internal satiety and hunger cues. Seventeen items (e.g., “I trust my
body to tell me how much to eat”) are rated on a 5-point scale from strongly disagree (1) to
strongly agree (5). Scores are averaged with higher scores reflecting greater intuitive eating.
The scale has demonstrated validity (Dockendorff et al., 2012). Internal reliability was
acceptable at Time 1 (α =.80) and Time 2 (α =.83) in the current sample.
Dieting behaviour. Frequency of dieting was assessed with one question asking
participants to rate the extent to which they have ever been on a diet in order to lose weight,
on a scale ranging from never (1) to always (5).
Fruit, vegetable and takeaway consumption. Girls responded to three questions
regarding their food intake. In Australia, dietary guidelines recommend the consumption of
two serves of fruit and five serves of vegetables daily (National Health and Medical Research
Council, 2013), with this quantity advertised widely through television and print campaigns
that aim to assist parents in increasing their children’s intake of fruit and vegetables
(Commonwealth of Australia, 2008). The first question asked participants to indicate (on
average) how many days during the week (i.e., 0 to 7) they consume at least two serves of
137
fruit. The second question asked how many days (on average) they consume at least five
serves of vegetables. The final question asked how many days in an average week
participants consume a takeaway (i.e., “fast food”) meal.
Sun protection. Sun protection was examined with five items adopted from the
Cancer Council Australia’s National Sun Protection Survey (see Dobbinson et al., 2008) used
previously with an adult female sample (Andrew et al., 2014). These questions examined
specific behaviours such as wearing sunscreen and staying in the shade during peak UV hours
in summer. Participants rated how often they performed each sun protection behaviour on a
5-point scale ranging from never (1) to always (5). The five items were summed to create a
total sun protection score (ranging from 5 to 25). Internal reliability for this scale was
acceptable (α = .70) at Time 1, and a little short of acceptable (α = .60) at Time 2.
Alcohol consumption. Participants were asked how many times they had ever
consumed alcohol with a choice of five responses ranging from zero (1) to 10 or more (5).
This question was considered the most appropriate assessment of alcohol consumption for
this sample, given that participants were under the age of legal alcohol consumption in South
Australia (18 years old) and legally should not have consumed any alcohol.
Cigarette smoking. Participants were asked how many cigarettes they had smoked in
their lifetime with four possible responses: none (1), 1 to 2 (2), 2 to10 (3) and 10 or more (4).
Due to the small number of participants who had ever smoked any cigarettes, responses were
dichotomised to none/some categories.
Weekly sleep. Participants were asked to indicate what time they fall asleep and wake
up on an average day during the week and on the weekend. Weekly sleep was calculated by
multiplying weekday sleep by five, and weekend sleep by two, and summing.
Seeking medical attention. One question asked how often participants go to a doctor
when they feel ill, rated on a 5-point scale ranging from never (1) to always (5).
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Demographics. The girls were asked to provide their age, year level at school and
ethnicity, and reported their weight and height measurements.
Procedure
The protocol used in the current study was approved by the relevant institutional
research ethics board, the Department for Education and Child Development Research Unit
and the Catholic Education Office. The Principal of each participating school was contacted
for permission to take part in the study. After permission was granted, parental consent was
obtained for both Time 1 and Time 2 participation through a package sent home with each
eligible girl containing a Letter of Introduction, Information Sheet and Consent Form. Girls
who were given parental consent also gave their own assent to participate on the day of data
collection. Participants completed both Time 1 and Time 2 questionnaires in normal class
time in groups. At each school, girls were offered the opportunity to enter into a raffle to win
one of several $20 vouchers for a clothing store as a gesture of appreciation for their time.
Results
Preliminary Analysis
Data were examined for missing values and deviations from normality. There was
only a small amount of missing data ranging from 0% (sports and physical activities) to
2.68% (takeaway consumption), and no substitution was undertaken. All continuous variables
were normally distributed, with low levels of skew (< 3) and kurtosis (< 10).
Changes Over Time
Table 1 displays the means and standard deviations for all variables at Time 1 and
Time 2. It can be seen that body appreciation increased significantly over time. Perceived
body acceptance by others, watching information based television, alcohol consumption and
cigarette smoking also increased significantly. On the other hand, appearance media
consumption and weekly sleep decreased over time. All correlations between Time 1 and
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Time 2 ranged from moderate to strong (r = .47 to r = .78).
Table 1
Mean and Standard Deviations, and t Values for Study Variables
Variable Time 1 Time 2 t value
Main variable
Body appreciation 3.39 (0.80) 3.49 (0.80) 2.84*
Predictors
Appearance media 25.24 (5.40) 24.00 (5.25) -5.50**
Non-appearance media
Non-fashion magazines 1.80 (0.96) 1.86 (0.97) 0.10
Cooking and construction T.V. 2.69 (1.04) 2.74 (1.08) 0.82
Information based television 2.63 (1.05) 2.76 (1.04) 2.30*
Activities
Sports and physical activity 483.73 (483.04) 515.44 (487.02) 1.17
Hobbies 380.89 (522.70) 370.03 (472.46) -0.37
Perceived body acceptance by others 4.04 (0.84) 4.15 (0.83) 2.65*
Self-objectification 4.54 (1.08) 4.52 (1.12) -0.16
Social comparison 12.19 (3.44) 11.98 (3.35) -1.27
Outcomes
Intuitive eating 3.22 (0.55) 3.20 (0.57) -0.52
Dieting behaviour 2.48 (1.44) 2.58 (1.38) 1.46
Fruit consumption 5.03 (1.88) 4.97 (1.78) -0.41
Vegetable consumption 3.56 (2.02) 3.44 (2.18) -0.65
Takeaway consumption 1.09 (1.05) 1.06 (1.13) -0.73
Sun protection 13.85 (3.93) 14.08 (3.51) 1.70
Alcohol consumption 1.68 (1.03) 2.20 (1.29) 7.81**
Cigarette smoking 1.05 (0.21) 1.12 (0.33) 4.45**
Weekly sleep (hours) 62.36 (6.24) 59.91 (6.83) -6.41**
Medical attention 3.29 (1.13) 3.26 (1.12) -0.55
*p <.05. **p < .001.
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Longitudinal Test of the Modified Acceptance Model of Intuitive Eating
Table 2 displays the correlations between variables contained within the modified
acceptance model of intuitive eating at Time 1, at Time 2, and cross-lagged (between Time 1
and Time 2). As can be seen, all variables were significantly correlated with each other at all
time points. In particular, in line with the modified acceptance model, the cross-lagged
correlations showed that perceived body acceptance by others at Time 1 was negatively
related to Time 2 self-objectification and social comparison, and positively related to Time 2
body appreciation and intuitive eating. Time 1 self-objectification and social comparison
were negatively related to Time 2 body appreciation and intuitive eating. Finally, Time 1
body appreciation was positively related to Time 2 intuitive eating.
The modified model of intuitive eating was examined using longitudinal change
regression models (Allison, 1990). Four regression models were performed representing
different steps in the model. In each model, age and intuitive eating at Time 1 were controlled
for by being entered in Step 1. Model variables and their respective change scores were
entered in Step 2. Time 2 intuitive eating was the outcome variable in all models. Results for
the four models are shown in Table 3, which presents the standardised coefficients (Betas).
It can be seen that in Model 1, Time 1 perceived body acceptance by others predicted
an increase in intuitive eating. In Model 2, which added Time 1 and change scores on self-
objectification and social comparison to Model 1, lower initial social comparison and
decreased self-objectification and social comparison from Time 1 to Time 2 predicted
increased intuitive eating, with perceived body acceptance by others still a significant
predictor. In Model 3, Time 1 body appreciation and change in body appreciation were added
to variables in Model 1. Here, higher Time 1 body appreciation and increased body
appreciation predicted increased intuitive eating. The addition of body appreciation in Model
3 decreased the effect of perceived body acceptance by others to non-significance. In Model
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4, all model variables were collectively entered. Body appreciation was the strongest
(positive) predictor of subsequent intuitive eating, reducing the significant effect of change in
self-objectification to non-significance, and decreasing the strength of the negative prediction
by social comparison.
Table 2
Correlations Within and Between Time for Modified Acceptance Model Variables
Within Time 1 PBA SO SC BA IE
Perceived body acceptance (PBA) -
Self-objectification (SO) -.19* -
Social comparison (SC) -.23* .53* -
Body appreciation (BA) .44* -.51* -.49* -
Intuitive eating (IE) .27* -.39* -.45* .48* -
Within Time 2
Perceived body acceptance -
Self-objectification -.23* -
Social comparison -.30* .70* -
Body appreciation .49* -.56* -.54* -
Intuitive eating .42* -.45* -.51* .56* -
Cross-lagged
Time 1 Time 2
Perceived body acceptance - -.21* -.25* .40* .32*
Self-objectification - .46* -.40* -.30*
Social comparison - -.42* -.38*
Body appreciation - .40*
Intuitive eating -
*p < .001.
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Table 3
Results (Standardised Regression Beta Coefficients) of Regression of Change in Intuitive
Eating on Perceived Body Acceptance by Others, Self-objectification, Social Comparison and
Body Appreciation
Overall, these results provide prospective support for the modified acceptance model
of intuitive eating. Specifically, perceived body acceptance by others and body appreciation
predicted a subsequent increase in intuitive eating, and social comparison and self-
objectification predicted a decrease in intuitive eating over a one-year time period. The final
model (Model 4) showed that body appreciation followed by social comparison were the
strongest prospective predictors of subsequent intuitive eating.
Predictors of Time 2 Body Appreciation
Table 4 displays the correlations between proposed predictors and body appreciation
separately within Time 1 and Time 2, and between Time 1 predictors and Time 2 body
Model 1 Model 2 Model 3 Model 4
Step 1
Age .03 .03 .03 .03
Intuitive eating T1 .61** .63** .61** .63**
Step 2
Perceived body acceptance T1 .17** .11* .09 .07
Self-objectification T1 -.08 -.02
Δ Self-objectification -.16* -.07
Social comparison T1 -.20* -.16*
Δ Social comparison -.23** -.16*
Body appreciation T1 .25** .17*
Δ Body appreciation .36** .26**
Final model adjusted R2 .395 .508 .507 .546
Note. Δ = change; *p < .05. **p < .001.
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appreciation. As can be seen, at both time points, perceived body acceptance by others was
positively related to body appreciation. In addition, appearance media was related negatively,
and reading non-fashion magazines was related positively, to Time 1 body appreciation.
Sports participation was positively related to body appreciation at Time 2. The cross-lagged
correlations showed a positive relationship between perceived body acceptance by others at
Time 1 and body appreciation at Time 2. There was also a positive relationship between Time
1 reading of non-fashion magazines and body appreciation at Time 2 (p = .050).
Table 4
Correlations Within and Between Time for Predictor Variables and Body Appreciation
Note. BA = body appreciation; ap = .05. *p <.05. **p < .001.
A series of hierarchical multiple regression analyses was conducted to test the
temporal precedence of the proposed predictor variables to body appreciation. Temporal
precedence occurs when one variable predicts change in another variable, whilst controlling
for initial levels of the outcome variable (Stice, 2002). For each regression, Time 1 body
Predictor variable
Within
T1
Within
T2
Cross-lagged: T1
predictor, T2 BA
Perceived body acceptance by others .44** .49** .40**
Appearance media -.14* -.10 -.07
Non-Appearance media
Non-fashion magazines .12* .09 .11a
Cooking and construction T.V. .06 .07 .06
Information based television .06 -.04 .02
Activities
Sports and physical activities -.07 .14* -.02
Hobbies -.00 .01 -.02
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appreciation was entered in Step 1, and the proposed predictor entered in Step 2. Time 2 body
appreciation was the outcome variable. Analyses showed that perceived body acceptance by
others at Time 1 was the only proposed predictor to temporally precede body appreciation,
R2
change = .007, Fchange(1, 291) = 4.55, β = .09, p = .03. The sign of the beta indicates that
greater perceived body acceptance by others at Time 1 predicted an increase in body
appreciation from Time 1 to Time 2.
We also examined the potential for reverse causation, that is, whether initial levels of
body appreciation predicted change in any of the postulated predictors. Here we found that
body appreciation at Time 1 predicted increased perceived body acceptance by others at Time
2, R2
change = .019, Fchange(1, 294) = 9.37, β = .15, p = .002, indicating that the relationship
between perceived body acceptance by others and body appreciation was bi-directional. Body
appreciation at Time 1 also predicted an increase in sports and physical activity participation
at Time 2, R2
change = .015, Fchange(1, 295) = 6.45, β = .12, p = .01.
Outcomes of Body Appreciation
A number of health-related outcomes were examined in relation to body appreciation.
Table 5 presents the correlations between body appreciation and health behaviours separately
at Time 1 and Time 2 (within time), as well as the correlations between Time 1 body
appreciation and Time 2 health behaviours. As can be seen, at both Time 1 and Time 2 girls
with higher body appreciation reported significantly more sun protection behaviours, weekly
sleep, seeking medical attention, and significantly less dieting, cigarette and alcohol
consumption. At Time 2, an additional negative relationship was found between body
appreciation and takeaway consumption. Cross-lagged correlations showed that body
appreciation at Time 1 was positively related to Time 2 sun protection, weekly sleep and
seeking medical attention, and negatively related to Time 2 dieting behaviour, alcohol
consumption and cigarette smoking.
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Table 5
Correlations Within and Between Time for Body Appreciation and Outcome Variables
Separate hierarchical multiple regressions were undertaken to examine whether Time
1 body appreciation temporally preceded change in health behaviours over a one year period.
In each regression, the Time 1 health behaviour was entered in Step 1, with Time 1 body
appreciation entered in Step 2. The Time 2 health behaviour was the outcome variable. Table
6 displays the results for Step 2 of the individual regressions. It can be seen that Time 1 body
appreciation significantly predicted decreased dieting behaviour, alcohol consumption and
cigarette smoking one year later. Time 1 body appreciation did not predict change in fruit,
vegetable or takeaway consumption, sun protection, weekly sleep or medical attention.
Outcome variable Within T1 Within T2
Cross-lagged:
T1 BA, T2
outcome
Dieting behaviour -.59** -.59** -.50**
Fruit consumption -.02 .05 .04
Vegetable consumption .03 .02 .08
Takeaway consumption -.05 -.19* -.09
Sun protection .21** .21** .22**
Alcohol consumption -.23** -.22** -.30**
Cigarette smoking -.11* -.12* -.19*
Weekly sleep .22** .25** .23**
Medical attention .19* .16* .12*
Note. BA = body appreciation; *p <.05. **p < .001.
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Table 6
Hierarchical Regression Results Predicting Outcomes from Time 1 Body Appreciation
Because there was generally low reported use of alcohol and cigarette consumption at
both time points, but these behaviours increased significantly over time (see Table 1), they
were examined in more detail. To do this, participants were split into quartiles based on Time
1 body appreciation, and the uptake of alcohol and cigarettes was examined for the lowest (M
= 2.33, SD = 0.47) and the highest body appreciation quartiles (M = 4.43, SD = 0.24). For
alcohol consumption, 53.4% of girls with low body appreciation had consumed some alcohol
at Time 1, with 71.9% reporting use by Time 2, representing an increase of 18.5%. In
contrast, for girls with high body appreciation, only 25.6% had consumed alcohol at Time 1,
increasing to 38.5% at Time 2, representing (a lesser) 12.9% increase. For cigarette
consumption, 6.7% of girls with low body appreciation had tried cigarettes at Time 1,
increasing markedly to 21.3% at Time 2, an increase of 14.6%. For girls with high body
appreciation, however, rates increased only a little, from 1.3% at Time 1 to 5.2% at Time 2,
an increase of only 3.9%. It can be seen that those girls with high body appreciation were not
Variable B SE B β ΔR2 ΔF
Dieting behaviour -.25 .09 -.15* .014 7.77*
Fruit consumption .05 .11 .02 .001 0.22
Vegetable consumption .08 .14 .03 .001 0.38
Takeaway consumption -.08 .07 -.06 .001 1.40
Sun protection .23 .16 .05 .003 2.02
Alcohol consumption -.30 .08 -.18** .032 13.77**
Cigarette smoking -.05 .02 -.13* .017 6.70*
Weekly sleep .61 .42 .07 .005 2.13
Medical attention .01 .07 .01 .000 0.01
*p <.05. **p < .001.
147
only less likely to consume alcohol or cigarettes initially, but were also less likely to take up
the behaviours over a one-year time period.
In order to examine the reverse relationships, that is, whether any of the postulated
health outcome variables predicted change in body appreciation over time, another series of
hierarchical multiple regressions was conducted. It was found that lower levels of Time 1
dieting predicted increased body appreciation at Time 2, R2
change = .009, Fchange(1, 291) =
5.51, β = -.12, p = .02, indicating that the relationship between body appreciation and dieting
was bi-directional.
Discussion
The current study sought to extend knowledge regarding prospective predictors and
outcomes of positive body image in adolescent girls. To date, few studies have explored body
appreciation in adolescents. Further, no longitudinal examinations of body appreciation have
been previously reported for any age group. The key findings from our study are clear. First,
a longitudinal test of the modified acceptance model of intuitive eating showed that perceived
body acceptance by others (positively), self-objectification and social comparison
(negatively), and body appreciation (positively) predicted an increase in intuitive eating over
one year in adolescent girls. Second, perceived body acceptance by others also prospectively
predicted an increase in body appreciation one year later. Finally, body appreciation itself
predicted decreased dieting behaviour, and alcohol and cigarette consumption, and increased
physical activity, one year later.
The first aim of the present study was to longitudinally examine the modified
acceptance model of intuitive eating in adolescent girls. Consistent with the postulated causal
model, we found that initially higher perceived body acceptance by others, lower self-
objectification and social comparison, and greater body appreciation predicted higher
intuitive eating over time. Our findings support previous correlational tests of the model in
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adult female samples (Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh et al.,
2012). However, the longitudinal research design of the current study has enabled
confirmation of the postulated temporal sequence of variables in the model, consistent with
their proposed causal role. Thus the findings highlight factors important in the development
of a healthy and adaptive eating style in adolescent girls.
In order to examine potential predictors of body appreciation, we measured several
variables that we reasoned might have a positive impact on body image. However, of the
postulated predictors tested, only perceived body acceptance by others prospectively
predicted an increase in body appreciation. Specifically, girls who initially felt more weight
and shape acceptance from their family and peers expressed greater appreciation for their
body one year later. This confirms longitudinally the association that has been shown in a
number of cross-sectional studies (Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006;
Kroon Van Diest & Tylka, 2010; Oh et al., 2012). It is likely that the girls in our study who
perceived that their body was accepted by those important to them, possibly through subtle
non-judgemental messages about appearance, may have been less likely to experience
preoccupation with appearance and instead feel respect and appreciation for their body (Tylka
& Wood-Barcalow, 2015a). In addition, prediction in the reverse direction was also found,
indicating that the relationship between perceived body acceptance by others and body
appreciation was bi-directional. Thus, girls with greater body appreciation may have
intentionally surrounded themselves with peers who were body positive and communicated
body acceptance (Tylka, 2011, 2012). This type of reciprocal relationship has been suggested
as a core feature of positive body image, and one that should serve to strengthen and maintain
positive body image (Tylka, 2011, 2012; Wood-Barcalow et al., 2010).
Although neither of our proposed classes of predictors regarding media or sports was
found to prospectively predict body appreciation, Time 1 appearance media consumption
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(negatively) and reading non-fashion magazines (positively) were related to Time 1 body
appreciation. Given the decreasing levels of appearance media consumption found between
Time 1 and Time 2, it may be that any effect of media consumption on body appreciation has
already been established by early adolescence, perhaps as a result of media saturation and
transmission of beauty ideals in Western society (Levine & Chapman, 2011). Furthermore, it
may not be the amount of media viewed by girls that is critical, but rather how it is viewed.
For example, girls with higher body appreciation may process appearance media more
critically, by analysing its content and consciously “filtering” messages in a way that is
protective and strengthens body image (Tylka, 2011; Wood-Barcalow et al., 2010). This is
consistent with results from two experimental studies which have shown body appreciation to
ameliorate negative effects on body image resulting from exposure to thin-ideal media
(Andrew et al., 2015a; Halliwell, 2013). Similar to media consumption, participation in
sporting activities was correlated with body appreciation within time but not over time.
The final aim of the present study was to examine a range of potential health
outcomes of body appreciation over one year. The only two other studies to have examined
health outcomes of body appreciation (Andrew et al., 2014; Gillen, 2015) were cross-
sectional in nature and sampled young adults. In our sample of adolescent girls, we found that
body appreciation predicted decreased dieting over a one year period, and that this
relationship was bi-directional. Our prospective findings extend previous correlational results
indicating a negative association between body appreciation and dieting behaviour in adult
women (Andrew et al., 2014; Gillen, 2015). Although we conceptualised participation in
physical activity as a potential predictor of body appreciation, we found instead that greater
initial body appreciation in our sample of girls was associated with increased participation in
sports and physical activity one year later. Future research might usefully examine more
150
precisely the nature of the relationship between body appreciation and engagement in
physical activity in samples of different ages.
Importantly, we found a significant prospective relationship between body
appreciation and alcohol and cigarette consumption. In particular, body appreciation was
found to predict uptake over time. Specifically, girls with high body appreciation were less
likely to take up smoking cigarettes or drinking alcohol between time points than their
counterparts with low body appreciation. This is a key finding of the current study because
alcohol and other drug use can have a negative impact on adolescent development in both
cognitive and social domains, and such use also increases the risk of accidental injury
(Hawkins, Catalano, & Miller, 1992). Collectively, these results provide empirical support to
the suggestion that individuals with body appreciation will engage in self-care behaviours
that benefit physical health, and actively avoid behaviours that could physically harm their
body (Tylka, 2011, 2012).
Practical Implications
Our results suggest that body appreciation has important implications for adolescent
girls. Indeed, body appreciation may have benefits for girls across a wide range of domains.
In particular, the findings from the current study suggest that fostering body appreciation may
be beneficial and protective for girls’ health, in terms of decreased dieting, increased physical
activity, and protection against alcohol and cigarette use. Given the high rates of dieting
among adolescent girls (e.g., Paxton et al., 1991), our finding in relation to decreased dieting
suggests that enhancing body appreciation might be one way to tackle the development of
maladaptive eating behaviours. The observed reciprocal relationship between body
appreciation and dieting also suggests that encouraging girls to take a balanced and non-
restrictive approach to food intake might help foster their body appreciation. Thus,
interventions and public health programs targeted at adolescents that focus on controlling
151
weight and diet may negatively impact on their body appreciation. More holistic programs
such as Health at Every Size ® (Bacon, Stern, Van Loan, & Keim, 2005) or BodiMojo
(Franko, Cousineau, Rodgers, & Roehrig, 2013) that focus on a healthy lifestyle, body
acceptance and challenging weight stigma are likely to be more beneficial for physical and
psychological health (Tylka et al., 2014).
Our results indicate that enhancing body appreciation may also improve girls’
participation rates in sports and physical activity. Australian figures show that participation in
sporting activities declines across adolescence at a considerably faster rate for girls than boys
(Australian Bureau of Statistics, 2013). This decrease may have a broad impact on the well-
being of adolescent girls, as physical activity has a wide range of demonstrated psychological
and physical health benefits (e.g., Warburton, Nicol, & Bredin, 2006). Thus, enhancing girls’
body appreciation may assist in increasing their participation in physical activity throughout
adolescence.
The findings from the current study suggest that body appreciation may influence the
uptake of alcohol consumption and cigarette smoking. Due to the known detrimental impacts
on physical health, current Australian national alcohol guidelines recommend that the safest
option for adolescents is to delay alcohol consumption for as long as possible (National
Health and Medical Research Council, 2009), and the uptake of adolescent cigarette smoking
is specifically targeted in the National Tobacco Strategy (Commonwealth of Australia, 2012).
Our findings indicate that middle adolescence may be an effective time point for
interventions to target alcohol and cigarette use. They also point to enhancing positive body
image as one way in which to protect adolescent girls from taking up, or at least delaying
engagement in, these unhealthy behaviours.
As previously suggested by Andrew and colleagues (2014), developing strategies that
aim to increase positive body image to target beneficial outcomes may prove a less
152
challenging task than attempting to reduce body dissatisfaction. As positive body image has
been shown to be distinct from negative body image (see Andrew et al., 2014; Avalos et al.,
2005; Tylka & Wood-Barcalow, 2015b), it may be possible to increase positive body image,
even in spite of some level of body dissatisfaction. This is particularly salient for adolescent
girls who are constantly confronted with media messages emphasising a narrow and often
unattainable standard of beauty (Levine & Chapman, 2011), and a high proportion of whom
are dissatisfied with their appearance (Wertheim & Paxton, 2011).
In order to better locate potential targets for increasing body appreciation, we
investigated a range of possible predictors, but had limited success. Perceived body
acceptance by others, but not media consumption or engagement in sporting or other
activities, prospectively predicted body appreciation one year later. Perceived body
acceptance by others may be targeted in two main ways. The first is to increase the
acceptance of girls’ appearance by significant others. Thus interventions might aim to
increase parental or peer awareness of the importance of displaying an accepting and non-
judgemental stance toward their daughters’ or friends’ appearance and body shape. The
second is to target adolescent girls themselves. Unhelpful thinking styles described in
cognitive behaviour therapy such as catastrophizing and black and white thinking (Beck,
1979; Beck, 2011) may contribute to an inaccurate and negatively biased perception of body-
related messages. Thus, cognitive behavioural interventions could incorporate training for
girls on unhelpful thinking styles and thought challenging. Alternatively, girls might be
trained in mindfulness and acceptance techniques that emphasise observation, but not
judgement or modification of thoughts, emotions or physical sensations (Baer, 2003).
Although we only found one major significant prospective predictor of body
appreciation in the current study, there may be other potential ways in which positive body
image can be fostered in adolescent girls. One possibility is to encourage engagement in more
153
embodying activities (see Menzel & Levine, 2011). Apart from yoga, we did not measure
other mindfulness-based activities like mindful meditation, which emphasise the mind-body
connection and might be more likely to enhance body appreciation. Increasing self-
compassion may be another way to enhance body appreciation. One study has shown self-
compassion to protect body appreciation against body image-related threats such as
appearance comparison in women (Homan & Tylka, 2015). Self-compassionate meditation
has also been shown to increase body appreciation in adult women (Albertson et al., 2014).
Thus, future research might explore whether self-compassion, via self-compassion training,
may be one way to increase body appreciation in adolescents. As suggested by Piran (2015),
already established body image intervention programs may also assist in increasing body
appreciation whilst simultaneously tackling negative body image. For example, a recent study
found that a one-hour dissonance-based intervention in which adolescent girls took part in
several activities that encouraged rejection of the thin ideal, not only decreased body
dissatisfaction but also increased body appreciation (Halliwell, Jarman, McNamara, Risdon,
& Jankowski, 2015). Therefore future body image interventions could usefully include
positive body image measures to explore which aspects of established intervention programs
assist in enhancing positive body image (Halliwell, 2015; Piran, 2015).
Limitations and Future Directions
As with all research, the current study contains limitations that need to be
acknowledged. First, although participating schools from which participants were sourced
ranged in socio-economic status, the sample comprised mainly girls in middle adolescence
who were Caucasian. This limits our ability to generalise findings to younger and older
adolescents, and to girls of different ethnicities. Future studies should attempt to survey a
more diverse range in terms of age, ethnicity, and geographical location. Second, we explored
only a limited number of potential predictors of body appreciation. Future studies might
154
attempt to include a greater range of predictors and use validated measures of these variables,
as our measures of media consumption and activities needed to be specifically constructed for
the current study. In addition, the most recent body appreciation (BAS-2, Tylka & Wood-
Barcalow, 2015b) and intuitive eating (IES-2, Tylka & Kroon Van Diest, 2013) scales were
not used as they were published after the commencement of the study. Finally, a one-year
time period between measurement points may not have been sufficient to detect some
changes. Nor may the measures have been administered at the critical developmental stage
for some aspects assessed. However, we were able to observe significant change and
prospective prediction of intuitive eating, dieting, physical activity, alcohol, and cigarette use.
Future research should endeavour to track adolescents over a longer time period, ideally from
early adolescence to young adulthood, in order to capture change more comprehensively.
Assessing body appreciation over several more time points would also be useful in ruling out
third variable explanations. More generally, longitudinal examination of predictors and
outcomes of body appreciation should also be extended to adult female samples.
Conclusions
Despite the above limitations, the current study has contributed to our understanding
of positive body image in adolescent girls. As one of few studies to examine body
appreciation in an adolescent population and the first to do so longitudinally, the findings
show that it is possible to detect prospective predictors and outcomes of positive body image
in adolescent girls over a relatively short time period of one year. The results provide
longitudinal support for the modified acceptance model of intuitive eating and highlight
perceived body acceptance by others as a predictor of body appreciation, and body
appreciation as a prospective predictor of decreased dieting, increased physical activity, and
decreased alcohol and cigarette use, over time. Taken together, the results suggest that body
155
appreciation is indeed a very salient concept in this age group, one associated with a wide
range of potential benefits.
156
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CHAPTER 7: General Discussion
Chapter Overview
The present thesis aimed to examine aspects of positive body image in young women
and adolescent girls. This was addressed in five studies that utilised cross-sectional,
experimental and longitudinal research designs. This final chapter seeks to integrate and
discuss the results and implications from these studies. The chapter first presents a brief
summary of the results, followed by a discussion of the research findings and their theoretical
and practical implications.
Summary of Findings
Studies 1 and 2 examined predictors and health outcomes of positive body image in
an undergraduate sample of women. Study 1 found that less appearance media and more non-
appearance media consumption and self-compassion predicted lower appearance processing
(i.e., lower self-objectification, social comparison and thin-ideal internalisation) which, along
with more perceived body acceptance by others, predicted greater body appreciation. Study 2
showed that body appreciation predicted more use of sun protection, greater screening for
moles and sun spots, and less weight-loss behaviour. Importantly, the level of prediction
offered was over and above that provided by body dissatisfaction.
Study 3 investigated a different type of positive outcome, specifically, whether
positive body image could protect women against negative effects resulting from thin-ideal
media exposure. The study found that women with higher body appreciation did not
experience an increase in body dissatisfaction after viewing fashion advertisements featuring
thin models, whereas women with lower levels did. This protective effect was not explained
by reduced state self-objectification, social comparison or greater use of the protective
processing strategies examined.
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Studies 4 and 5 turned to the investigation of positive body image in adolescent girls.
Study 4 cross-sectionally confirmed a modified acceptance model of intuitive eating,
whereby greater perceived body acceptance by others and lower self-objectification and
social comparison predicted greater body appreciation and intuitive eating in girls. Study 5
longitudinally confirmed the modified model. This study also identified a number of
prospective relationships. Specifically, girls who perceived others as more accepting of their
body and engaged in less dieting, reported greater body appreciation one year later. In
addition, girls who initially had higher body appreciation were more likely to eat intuitively
and participate in sport, and were less likely to diet, smoke cigarettes or drink alcohol over
the one-year time period.
Implications for the Major Aims
The first major aim of the thesis was to examine predictors of positive body image in
women and girls. Together, the set of studies have identified a number of predictors. In
particular, greater perceived body acceptance by others emerged as the most consistent
predictor of body appreciation cross-sectionally and prospectively, in both women and girls
(Studies 1, 4 and 5). This finding lends support to previous results for adult women
(Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006; Oh, Wiseman, Hendrickson,
Phillips, & Hayden, 2012), and extends the finding to adolescent girls. Lower self-
objectification and social comparison also predicted greater body appreciation in women and
girls (Studies 1, 3, 4 and 5), replicating and extending prior studies with women (e.g., Avalos
& Tylka, 2006; Homan & Tylka, 2015). In addition, lower thin-ideal internalisation and self-
compassion were shown to be associated with greater body appreciation in women (Study 1),
as has been demonstrated previously (e.g., Swami, 2009; Wasylkiw, MacKinnon, &
MacLellan, 2012).
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In an effort to expand upon previous research, we also sought to examine physical
activity and media consumption as two types of everyday activities that may predict positive
body image. Although participation in sports and physical activity was not correlated with
body appreciation in women, it was in girls (Studies 1 and 5). Women’s physical activity
was, however, related to lower self-objectification, itself associated with greater body
appreciation. Overall, media consumption was found to be relevant for positive body image.
Lower consumption of appearance-focussed media was related to greater body appreciation
in women and girls (Studies 1 and 5). Relatedly, the consumption of non-appearance media
predicted body appreciation indirectly via lower appearance processing in women (Study 1),
and the reading of non-fashion magazines was positively correlated with body appreciation in
girls (Study 5).
Overall, the results addressing the first aim of the thesis not only lend support to some
previous findings, but also extend the literature in at least three important ways. First, the
studies have considerably broadened the scope of possible predictors of positive body image.
In particular, the everyday activities of sports participation and media consumption were
identified as predictors, adding to those psychological predictors previously confirmed in
women. Second, the investigation of predictors was extended to adolescent girls for the first
time. The significant predictors that were identified largely mirrored those found for women.
Third, prospective predictors of positive body image were identified in the longitudinal
follow-up with girls, with greater perceived body acceptance by others and less dieting
behaviour predicting positive body image over one year. Thus, the studies have made a start
on Tylka’s (2011) suggestions to identify the strongest predictors (including prospective
predictors) of positive body image (research question 4), and to examine how positive body
image presents in populations outside of young women (research question 2). Future studies
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should explore other types of predictors. Such research should also be extended to groups
other than young women and adolescent girls.
The second major aim of the thesis was to examine outcomes of positive body image.
The findings provided evidence for a number of positive health consequences. Intuitive
eating was confirmed as an outcome of positive body image in adolescent girls cross-
sectionally (Study 4) and prospectively (Study 5), thereby extending previous correlational
results among women (e.g., Avalos & Tylka, 2006). Importantly, body appreciation was also
associated with a number of other previously untested health outcomes. Women and girls
with greater body appreciation were more likely to protect their skin from the sun, see a
doctor when needed and not engage in dieting behaviour (Studies 2 and 5). In the longitudinal
study, girls with greater initial body appreciation were less likely to start drinking alcohol or
smoke cigarettes (Study 5). On the other hand, women’s body appreciation was not related to
their alcohol or cigarette consumption. This illustrates how the role of positive body image in
relation to certain health behaviours may vary depending on stage of development.
Accordingly, it would be useful to examine the prospective relationships between positive
body image and health behaviours across the period of time spanning childhood to adulthood.
In addition to outcomes related to physical health, women with higher body
appreciation were less likely to experience an increase in body dissatisfaction as a result of
viewing advertisements containing thin models. This result adds to the one previous
experiment that has shown a protective role for body appreciation against thin-ideal induced
body image disturbance (Halliwell, 2013). In addition, the study was able to identify some
protective processing strategies that women use to manage thin-ideal media. For example,
women with greater body appreciation reported that they were more aware that images are
altered, understood that the majority of the population do not look like models, and paid little
attention to images with body types that are personally unattainable.
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Overall, the findings across the studies have identified a range of possible outcomes
stemming from positive body image. In so doing, the research has helped to address Tylka’s
(2011) call for investigations of physical health benefits of positive body image (research
question 5), and the identification of outcomes of positive body image more generally
(research question 4). Future studies might explore other health outcomes, such as keeping up
to date with required vaccinations or the use of illicit substances, as well as outcomes in
different domains, such as educational or occupational settings.
Theoretical Implications
The results have a number of implications for the theoretical understanding of positive
body image. First, additional evidence has been provided for the conceptualisation of positive
body image as distinct from low body dissatisfaction. Specifically, Study 2 demonstrated a
different pattern of correlations between body appreciation and body dissatisfaction and some
health outcomes. In particular, only body appreciation was related to sun protection
behaviours, and only body dissatisfaction was related to alcohol consumption. Regression
analysis also showed that body appreciation predicted sun protection behaviours, skin
screening for sun spots and weight-loss behaviour, over and above levels of body
dissatisfaction. As such, the findings demonstrate the utility of specifically investigating
positive body image, as was called for over a decade ago (Cash & Pruzinsky, 2002).
Second, the present thesis has advanced testing of the acceptance model of intuitive
eating (Avalos & Tylka, 2006). This model involving body appreciation as a key predictor
was shown to apply in the sample of adolescent girls both cross-sectionally and prospectively
(Studies 4 and 5). The application of the model in girls is particularly useful because of the
high rates of body image disturbance and disordered eating in this population (Paxton et al.,
1991; Wertheim & Paxton, 2011). The acceptance model of intuitive eating was also
modified to include appearance comparison, which was shown to be the strongest predictor of
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intuitive eating behind body appreciation. Thus, appearance comparison might be considered
for inclusion in future tests of the model.
Third, the thesis also sought to expand on the understanding of “protective filtering”
(Tylka, 2011, 2012; Wood-Barcalow, Tylka, & Augustus-Horvath, 2010), which is proposed
to be one component of positive body image. Protective filtering was examined in the context
of exposure to thin-ideal media (Study 3). Young women with greater body appreciation were
more likely to process (i.e., “filter”) appearance ideals portrayed in thin-ideal advertisements
in a way that was protective for body image. This was the case for both reported general use
of processing strategies in everyday life, and use of processing strategies during the
experiment. Thus the results have begun to address Tylka’s (2011) suggestion to examine
how filtering is protective (research question 3).
Finally, as was noted in Chapter 1, the relationships between positive body image and
different environmental factors are proposed to exist in reciprocal manner which serves to
maintain and strengthen positive body image (Tylka, 2011, 2012; Wood-Barcalow et al.,
2010). For example, individuals who perceive others as accepting of their appearance are
likely to possess greater body appreciation, which in turn will encourage them to surround
themselves with like-minded people who have an accepting stance toward appearance, further
enhancing perceptions of body acceptance. The longitudinal study with girls enabled such
postulated bi-directional relationships to actually be tested (Study 5). Indeed, significant bi-
directional relationships were found between body appreciation and greater perceived body
acceptance by others as well as lower dieting. To the best of our knowledge, these findings
provide the first demonstration of reciprocal relationships involving positive body image.
Practical Implications
The results also have a number of practical implications. As identified in the studies,
there are several benefits to possessing positive body image, and thus increasing positive
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body image is a worthwhile aim for interventions. Indeed, it is possible that interventions that
specifically seek to increase levels of body appreciation will be more successful than those
that attempt to reduce body dissatisfaction. Body dissatisfaction has become normative for
women and girls in Western cultures and is difficult to change because of continual
reinforcement by appearance messages (e.g., in the media) that place importance and
emphasis on being thin. In addition, initial research suggests that it may be possible for
individuals to experience body appreciation while still experiencing some level of body
dissatisfaction (Tiggemann & McCourt, 2013). Thus positive body image can potentially be
fostered without needing to simultaneously reduce levels of body dissatisfaction.
Importantly, a number of predictors were identified that might be targeted to enhance
positive body image. In particular, given that perceived body acceptance by others was the
most consistent predictor, the results suggest that one way to increase body appreciation is to
modify how accepting other people are of one’s appearance. This could be achieved by
educating those people closest to women and girls, for example, their mothers, fathers,
spouses or friends, about the importance of showing an accepting stance towards the
appearance of the women and girls in their lives. Alternatively, women and girls’ perceptions
could be targeted, particularly if the perceptions held are negatively biased and inaccurate.
For example, cognitive behaviour therapy techniques (e.g., Beck, 1979; Beck, 2011) could be
used to highlight and critically examine negative appearance related automatic thoughts and
perceptions.
Another predictor identified in women was self-compassion. In Western societies,
people are continuously confronted with different types of appearance-related information
and feedback from sources such as the media, peers, and one’s own personal judgements. As
a great deal of this information can be negative, possessing an accepting, kind and non-
judgemental outlook may assist in dealing with information in a way that strengthens positive
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body image. A recent study examining a meditation intervention that included self-
compassion training was shown to improve levels of reported body appreciation in women
(Albertson, Neff, & Dill-Shackleford, 2014). Thus, interventions that enhance self-
compassion could be explored as a way to foster body appreciation.
Consistent with the embodiment model of positive body image (Menzel & Levine,
2011) and the acceptance model of intuitive eating (Avalos & Tylka, 2006), lowered self-
objectification was consistently associated with greater body appreciation across several of
the studies. Thus, decreasing self-objectification is another possible option to enhance body
appreciation. One way to achieve this might be to increase the focus on the body’s
functionality, as opposed to the focus on appearance inherent in self-objectification. For
example, women and girls could be encouraged to engage in activities such as yoga, rock
climbing or acrobatics. Alternatively, interventions might specifically direct attention and
thought to body functionality. A recent study found that an intervention involving structured
writing assignments about the functions of one’s body resulted in reduced self-objectification
and increased body appreciation in young women (Alleva, Martijn, Van Breukelen, Jansen, &
Karos, 2015). Such a brief and non-invasive strategy could be relatively easily implemented
in school and university settings.
Finally, lower social comparison on the basis of appearance was also associated with
greater body appreciation among women and girls in a number of the studies, and so could be
targeted to influence body appreciation. For example, interventions could focus on
emphasising the inappropriateness of comparison targets. This could be achieved by
increasing awareness of the artificial nature of media images, including how only a narrow
range of body types (i.e., very thin) are commonly represented, and that digital modifications
and enhancements are regularly made to images. Another strategy is to increase awareness
that our body shape and composition is largely genetically pre-determined and therefore the
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majority of the population simply cannot look like the models in the media. Similar strategies
have previously been shown to lessen negative impacts on body image as a result of thin-
ideal media exposure (Posavac, Posavac, & Weigel, 2001).
A broader practical implication of the findings is that increasing body appreciation
should have a wide range of beneficial outcomes for women and girls. In particular, fostering
body appreciation should encourage behaviours that benefit health, and lessen or prevent
engagement in behaviours that might compromise health. Such behaviours include those
identified in the thesis (e.g., more sun protection, less dieting), but may also extend to others
such as decreasing the use of illicit substances or engagement in other risky behaviours. Thus,
community and government-led health and well-being programs might consider enhancing
body appreciation as a way to influence a range of health outcomes in young adult women
and adolescent girls.
Conclusion
The present thesis has examined positive body image in young women and adolescent
girls across five studies using different methodologies. The studies have identified a number
of predictors and positive outcomes of body appreciation. Theoretically, the findings
contribute to the conceptualisation of positive body image as distinct from negative body
image. Practically, the findings identify a number of ways in which to enhance body
appreciation, and show that this may offer a broad range of benefits. Overall, the results
indicate that positive body image is an important contributor to the well-being of adolescent
girls and young adult women.
173
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